RELATIONSHIPS AMONG BLACK WOMEN’S WELLNESS, GENDERED-RACIAL
IDENTITY, AND MENTAL HEALTH SYMPTOMS
A Dissertation
Presented to
The Graduate Faculty of the University of Akron
In Partial Fulfillment
of the Requirements for the Degree
Doctor of Philosophy
Stephanie A. Dykema, M.Ed.
August, 2017
RELATIONSHIPS AMONG BLACK WOMEN’S WELLNESS, GENDERED-RACIAL
IDENTITY, AND MENTAL HEALTH SYMPTOMS
Stephanie A. Dykema
Dissertation
Approved: Accepted:
______Faculty Advisor School Director Dr. Ingrid Weigold
______Committee Member Dean of the College Dr. Kathryn Feltey
______Committee Member Executive Dean of the Graduate Dr. Dawn Johnson School
______Committee Member Date Dr. John Queener
______Committee Member Dr. Suzette Speight
______Committee Member Dr. Rebecca Erickson
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ABSTRACT
Black women experience several unique influences on their wellness and mental health symptoms, including gendered-racism, religion/spirituality, cultural beliefs, controlling images/stereotypes, and gendered-racial identity. Counseling psychologists are called to recognize these individual and sociocultural influences on clients, viewing clients holistically and within their cultural context. This study explored how psychological well-being and optimal beliefs related to Black women’s gendered-racial identity and mental health symptoms. This study also assessed the factor structure of Ryff’s Scales of
Psychological Well-being measure for Black women and identified a suitable two-factor structure for this sample. Across qualitative and quantitative results, optimal beliefs contributed uniquely to Black women’s definition of wellness. Liberation/empowerment, an optimal worldview, trusting relationships, and confidence to manage future challenges were related to fewer mental health symptoms in this sample. Study results also clarified that Black women who have high private regard and whose gendered-racial identity is central to their self-concept endorse trusting relationships and optimal beliefs as central components of their wellness. These results suggest counseling psychologists must move beyond multicultural knowledge to engage in social justice action that creates liberation for Black women and challenges the suboptimal system currently in place in dominant society. Taking such action and enacting social justice is necessary to decrease the mental health disparities experienced by Black women and to be an ally in their empowerment.
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TABLE OF CONTENTS
Page
LIST OF TABLES…………………………………………………………………….…vii
LIST OF FIGURES………………………………………………….………………….viii
CHAPTER
I. INTRODUCTION……………………….………………………………….……...... …1
Overview of Wellness Literature………………………………………….………2
Black Women’s Wellness………………………………………………….....…...7
Purpose of the Current Study..…………………………………………...... …...10
II. A REVIEW OF THE LITERATURE………………………………...………...…….12
Uniqueness of Black Womanhood .……...………………………………..…….14
Black Women’s Wellness and Mental Health Symptoms..…………….……..…17
Cultural Models of Wellness………………………………………………...…..24
Optimal Theory……………………………...……………………………...……29
Alternative Models of Wellness………………….……………………...……....44
Ryff’s Psychological Well-being Model…………………………….…..……....47
The Role of Racial Identity in Wellness…………………………….…….…...... 60
Multidimensional Model of Racial Identity……………………………...…..….64
Black Women’s Gendered-Racial Identity and Wellness………………....…….69
Summary and Hypotheses……………..….…….……………………………….73
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III. METHOD……………………………...…………………………………………….78
Participants…………………………………………………….……………...... 78
Recruitment Procedures……………………………………………………...... 80
Measures………………………………………………………...…………..…...84
Intersectionality in the Current Study……………………………..…...……….101
Research Questions and Hypotheses………………………………….….…….104
Proposed Analyses……...…………………………………………….……..….105
Conclusion……...…………………………………………………….….….….111
IV. RESULTS……...……………………………...... …………………………..….….112
Data Cleaning……...……………………………………………………..….….112
Demographics of Participants……...…………………………………...…...….114
Basic Relationships………………………………………………...…..……….117
Content Analysis……...…………………………………...……………..….….121
EFA of Ryff’s SPWB……...…………………………………………….….….127
Regression Analyses.………………………………………………………..….133
Canonical Correlation Analyses………………………………….…….…...….135
V. DISCUSSION……...………………………………..……………...….….……..….138
Defining Black Women’s Wellness……...………..…………………….….….138
The Importance of an Optimal Worldview for Black Women’s Wellness…….143
Relationships among Gendered-Racial Identity and Wellness……...………….146
Integration and Summary of Results……...……………………..………….….147
Limitations and Future Directions……...…………………………….….….….151
Conclusion……...…………………………….………………………….….….159
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REFERENCES……………………………………………………………………....…161
APPENDICES…………………………………………………………………….…....200
APPENDIX A. PARTICIPANT INFORMED CONSENT FORM………...….201
APPENDIX B. UA STUDENT PARTICIPANT INVITATION…………...... 203
APPENDIX C. COMMUNITY PARTICIPANT WEBSITE INVITATION….204
APPENDIX D. NON-UA STUDENT PARTICIPANT EMAIL INVITATION…………………………………………………………………..205
APPENDIX E. DEBRIEFING STATEMENT…………………………..……..207
APPENDIX F. RECRUITMENT UNIVERSITIES.………………….……...... 209
APPENDIX G. DEMOGRAPHICS QUESTIONNAIRE...……………...…….211
APPENDIX H. MULTIDIMENSIONAL INVENTORY OF BLACK IDENTITY…………………………………………………………………...…214
APPENDIX I. SCALES OF PSYCHOLOGICAL WELL-BEING...... 216
APPENDIX J. OUTCOME QUESTIONNAIRE 45.2……………………...... 219
APPENDIX K. BELIEF SYSTEMS ANALYSIS SCALE……….…...……….222
APPENDIX L. GIFT CARD E-MAIL TO PARTICIPANTS………………….225
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LIST OF TABLES
Table…………………………………………………………………...………………Page
1 Comparison of Optimal and Suboptimal Worldview……………………....……33
2 Comparison of High and Low Psychological Wellbeing……………………..…50
3 Demographic Characteristics………………………………………………...…115
4 Descriptive Statistics of Scales and Subscales………………………….………118
5 Correlations among Scales and Subscales……………………..……….………119
6 Content Analysis for Question one: How do you define wellness?.………....…123
7 Content Analysis for Question two: What does your life look like when you’re doing well?……………………..……………………………………………….125
8 Factor Loadings for the Final Model of Ryff’s SPWB with Black women…….131
9 Summary of Multiple Linear Regression for SPWB Relating to Mental Health Symptoms………………………………………………………………………133
10 Summary of Hierarchical Linear Regression for SPWB and Optimal Beliefs
Relating to Mental Health Symptoms………………………...………...………135
11 Canonical Loadings from Canonical Correlation Analysis…………...……..…136
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LIST OF FIGURES
Figure Page
1 Canonical Correlation Analysis of Wellness and Identity……………...………110
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CHAPTER I
INTRODUCTION
As counseling psychologists we are called to understand individuals developmentally and holistically, recognizing the unique facets of each individual while seeing them as a whole person (Packard, 2009). We are also called to conceptualize individuals within their social context and recognize the influence of cultural factors and societal oppression on their well-being (Sue & Sue, 2008; Vera & Speight, 2003). Black women experience unique factors that influence their mental health and wellness including: gender and racial identities, religion/spirituality, racism, sexism, and gendered- racism, and lack of culturally competent mental health treatment, to name a few (Brown
& Keith, 2003). The current study explores both individual and sociocultural influences on Black women’s wellness and mental health symptoms. Specifically, this study examines individual factors of gendered-racial identity and psychological well-being and sociocultural factors of Afro-cultural beliefs. Counseling psychologists are also called to utilize our holistic, culturally-informed perspective to foster client’s positive growth, not just remediate illness (Packard, 2009) and to create societal change, not just help clients
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adapt to oppression (Vera & Speight, 2003). This study aims to do both by equipping counseling psychologists with knowledge about the individual and cultural influences on
Black women’s mental health symptoms in order that they can increase wellness and decrease mental health disparities in this population. This chapter begins by discussing the research on wellness within psychology, then locating the current study within this larger conversation. I then explore the unique aspects of wellness for Black women and the mental health disparities experienced by this population. I conclude this chapter by discussing the aims of the current study and the ways it addresses critical issues in the literature and mental health disparities among Black women.
Overview of Wellness Literature
Wellness is a multifaceted construct that reflects a person’s optimal experience and overall functioning (Ryan & Deci, 2001, p. 142). Wellness considers functioning in cognitive, affective, relational, spiritual, and collective domains (Prilleltensky & Fox,
2007; Prilleltensky & Prilleltensky, 2003; Ryan & Deci, 2001). Whereas wellness is a broad construct reflecting functioning across multiple domains, well-being is a narrower term used to reflect functioning within a specific domain (e.g. intrapersonal, occupational; Lent, 2004; Prilleltensky & Prilleltensky, 2003; Ryan & Deci, 2001). The field of psychology as a whole has historically emphasized pathology and dysfunction and is attempting to counteract this imbalance by exploring positive psychological functioning (Albee, 2000; Seligman, 2002).
Within the field of psychology, research on wellness has typically focused on individual/intrapsychic well-being, and not overall wellness or cultural forms of wellness
(Moradi, 2012; Prilleltensky & Fox, 2007; Prilleltensky & Prilleltensky, 2003). In
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particular, researchers have focused on psychological well-being as a measure of individual/intrapsychic well-being (Lent, 2004; Moradi, 2012; Yoder, Snell, & Tobias,
2012). Psychological well-being (PWB) reflects a person’s emotional and physical health, their ability to be fully, independently functioning, and the extent to which they believe their life has meaning, growth, and purpose (Ryff & Keyes, 1995; Waterman,
1993). The current wellness literature is focused on identifying predictors of PWB, ranging between metacognitive beliefs, interpersonal relationships, and genetics (e.g.
Abdelrahman, Abushaikha & al-Motlaq, 2014; Awan & Stiwat, 2014; Cakir, 2014;
Keresteš, Brković, & Jagodić, 2012; Moltafet & Khayyer, 2012; Rowold, 2011; Uzenoff et al., 2010; Valiente, Prados, Gómez, & Fuentenebro, 2012).
There are many problems with the field of psychology focusing on individual/internal wellness without consideration of cultural factors or other models of wellness. First, the field assumes that defining wellness in terms of intrapsychic factors is adequate for most, if not all, people (Christopher, 1999; Constantine and Sue, 2006;
Frazier et al., 2006; Moradi, 2012; Prilleltensky & Fox, 2007). However, making this assumption ignores racial and gender cultural values in favor of the White, masculine,
Western values of self-orientation, individualism, and mind-body separation
(Christopher, 1999; Daraei, 2013; Mehrotra et al., 2013). Cultural models of wellness may better encompass the values of marginalized communities (Frazier et al., 2006; Sue
& Sue, 2008). For instance, values of collectivism, spirituality, and interconnectedness among communities of Color often lead to defining wellness in interpersonal, collective, and spiritual terms, not individual terms (Christopher, 1991; Constantine and Sue, 2006).
The current psychological literature has not explored such a definition of wellness even
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though cultural models of wellness exists (Speight et al., 2009). The current study recognizes the needs for a balanced approach to researching wellness by encompassing both individual and cultural factors. Indeed, individual and cultural factors equally impacted Black women’s wellness (Perry, et al., 2013). This suggests that we should continue to explore Black women’s individual well-being while also using a cultural model of wellness.
Another trend in the wellness literature within psychology is the appropriateness of wellness measures and theories for racially diverse groups, especially international populations (Chang & Chen, 2005; Fernandes et al., 2010; Kishida et al., 2004; Lindfors et al., 2006; Sirigatti et al., 2013). Specifically, researchers in the field of psychology are testing the appropriateness of PWB in internationally racially diverse groups, however the utility of PWB for racially diverse groups in the United States remains underresearched (Constantine & Sue, 2006; Frazier, Lee, & Steger, 2006; Daraei, 2013;
Mehrotra, Tripathi, and Banu, 2013). Additionally, many of the studies testing the appropriateness of wellness measures for diverse groups compare people of Color and
White people (e.g., Abu-Rayya, 2006; Molix & Bettencuort, 2010; Seaton et al., 2006).
As a result, there is limited information about within-group differences in identity and wellness. Indeed, there is limited research on what wellness means to Black women specifically (Brown & Keith, 2003; Speight et al., 2012; Wyatt, 2003).
The extant wellness literature also uses demographic variables, such as race or gender, to test group differences (e.g. Daraei, 2013; Huppert, 2009; Ryan & Deci, 2001;
Ryff & Keyes, 1995; Keyes et al., 2002), resulting in a lack of complex measurement of identity. When exploring wellness in diverse groups, it is important to go beyond
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demographic variables, such as race or gender, to measure attitudes, beliefs, and behaviors associated with cultural identities (Constantine & Sue, 2006). There is theoretical (see Haslam, Jetten, Postmes, and Haslam, 2009; Tajfel & Turner, 1979;
1986) and empirical support for linking racial identity to well-being outcomes in people of Color in general (Molix & Bettencourt, 2010; Constantine & Sue, 2006) and African
Americans specifically (Seaton, Scottham, & Sellers, 2006; Seaton, Neblett, Sellers,
Upton, & Hammond, 2011). For instance, research suggests racial identity predicts PWB for people of Color but not White people (Abu-Rayya, 2006; Molix & Bettencuort, 2010;
Seaton et al., 2006). However, there is limited research on how multiple identities, such as gendered-racial identity, intersect and impact wellness.
Overall, the wellness literature within the field of psychology has several gaps.
More research is needed beyond individual/intrapsychic forms of wellness. The current study recognizes the needs for a balanced approach to researching wellness by encompassing both individual and cultural models of wellness. Additionally, more research is needed on within-group differences on wellness and how intersectional cultural identities link to wellness. This suggests that we should explore wellness within a specific group using a robust measure of their various identities, which is the approach utilized in the present study.
Wellness and Counseling Psychology
As a sub-field, counseling psychology is uniquely positioned to address these gaps in the psychological wellness literature. Counseling psychology has historically been focused on the study of positive psychological functioning (Lopez et al., 2006). In a
40-year content analysis of counseling psychology journals, almost 30 percent of articles
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were focused on positive aspects of human functioning (Lopez et al., 2006). This emphasis on health and positive functioning is the result of our developmental, holistic, and strengths-based values (Packard, 2009). These values not only distinguish counseling psychology from other sub-fields that are pathology-focused, but they also orient counseling psychologists to focus on wellness and optimal functioning in interventions, prevention, and research (Lopez et al., 2006; Mollen, Ethington, & Ridley, 2006).
Our counseling psychology values of multiculturalism, social justice, and recognition of cultural diversity also offer unique strengths compared to the broader field of psychology (Packard, 2009; Speight & Vera, 2003). Counseling psychologists have made significant contributions to the psychological literature on the interconnectedness of cultural identities and psychological phenomenon, for instance: racial and gender identity development (Helms, 2007; Moradi, 2005; Parham & Helms, 1981), impact of oppression on wellness (Carter, 2007; Lee & Ann, 2011; Prilleltensky & Prilleltensky,
2003), and the concept of microaggressions (Sue, 2009; Sue, 2010; Sue & Sue, 2008).
Given these research contributions and our core values, counseling psychology in uniquely positioned to offer a much-needed, culturally-informed perspective on wellness.
Indeed, one specific area of growth within the wellness literature is to better understand the multicultural aspects of positive human functioning (Frazier et al., 2006).
The current study capitalizes on the strengths within counseling psychology to explore individual and cultural factors of Black women’s wellness and gendered-racial identity. The next sections discusses the facets that uniquely impact Black women’s wellness and how the current study accounts for both individual and cultural influences on Black women’s wellness.
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Black Women’s Wellness
Black women experience several unique factors that impact their wellness. First, when conceptualizing Black women’s wellness, it is essential to consider both their race and gender identities (Brown & Keith, 2003) and to use an intersectional perspective
(Capodilupo & Kim, 2014; Crenshaw, 1993; Cole, 2009; D’Andrea & Heckman, 2008;
Reid & Kelly, 1994). Intersectionality refers to the connectedness of multiple cultural identities wherein identities are unable to be separated and their combination results in unique lived experiences (Crenshaw, 1993). Intersectionality is especially important for
Black women (Capodilupo & Kim, 2014; Reid & Kelly, 1994), given that Black women endorse that an intersected, Black-woman identity is more salient to their self-concept than separate Black and woman identities (Settles, 2006).
Because their gender and racial identities are both devalued by society, Black women encounter racism, sexism, and gendered racism (Collins, 2000; Perry et al.,
2013). Gendered racism is experiencing racism and sexism simultaneously, a phenomenon distinctive to women of Color and Black women especially (Lewis et al.,
2013). Studies suggest that racism, sexism, and gendered racism significantly and uniquely predict lower well-being and poorer mental health outcomes for Black women
(Cadilupo & Kim, 2014; Fischer & Bolton Holz, 2010; Moradi & Subich, 2003; Perry,
Harp, & Oser, 2013; Perry, Pullen, & Oser, 2012). Thus, when trying to understand what wellness means to Black women we must also understand the multiple sources of oppression that impact their wellness (Prilleltensky & Prilleltensky, 2003).
Black women also experience several stereotypes based on the combination of their gender and racial identities (Collins, 2000). For instance, Black women are
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stereotyped as Mammy, Jezebel, Sapphire, and Superwoman (see Collins, 2000;
Beauboeuf-Lafontant, 2009; Lewis, Mendenhall, Harwood, & Huntt, 2013). This portrayal occurs in research as well, where Black women are subjects of research on
“deviant” female experiences (e.g., teenage pregnancy, female criminals) and neglected in research on “common” female experiences such as self-esteem and well-being (Reid &
Kelly, 1994). The current study addresses this problem by focusing on Black women’s wellness, not only as a “common”, or more general, female experience, but also as a strengths-based, positive construct in which Black women are viewed “as enactors, not victims” (Reid & Kelly, 1994, p. 483).
Black women may develop significant mental health symptoms as a result of the racism, sexism, gendered-racism, and stereotypes they experience (Brown & Keith, 2003;
Cadilupo & Kim, 2014; Fischer & Bolton Holz, 2010; Moradi & Subich, 2003; Perry,
Harp, & Oser, 2013; Perry, Pullen, & Oser, 2012; Sue & Sue, 2008). Black women represent 11 to 12% of the U. S. population but account for 25% of people with mental health needs (Leary, 2012). Specifically, Black women are 1.6 times more likely to report feelings of sadness, hopelessness, and worthlessness as compared to their White counterparts (CDC, 2012). At any given time, between 16 and 28% of Black women experience clinical depression, and an even higher rate experience subthreshold symptoms of depression (Brown & Keith, 2003). Black women are more likely to attempt suicide than Black men, resulting in 449 suicides in 2012 (AAS, 2014). They also experience higher rates of anxiety, phobias, post-traumatic stress, somatization, and overall psychological distress than Black men, White men, and White women (Brown &
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Keith, 2003). Overall, Black women are more likely to experience mental health symptoms compared to other populations.
Despite these higher rates of mental illness among Black women, they are less likely to have access to mental health treatment and psychotropic medications than White women (National Healthcare Disparities Report, 2010). Additionally, they are less likely to engage in psychological help-seeking behavior (SAMHSA, 2011) and may minimize their symptoms in an effort to abide by expectations of the strong Black women stereotype (Beauboeuf-Lafontant, 2009; Brown & Keith, 2003; Leary, 2012). Even when they do have access to treatment and seek it out, they are more likely to utilize private physicians, family and friends, pastoral services, and social service agencies rather than mental health services due to fear of stigma and mistreatment (Caldwell, 2003). Black women are also more likely than their White counterparts to experience biased diagnoses and treatment from mental health professionals (Brown & Keith, 2003; Sue & Sue,
2008). As a result of the barriers to care and mistreatment they experience, this population is likely to prematurely terminate from mental health services (Brown &
Keith, 2003). The current study addresses these disparities by identifying the unique factors that define and contribute to Black women’s wellness, thereby helping counseling psychologists become allies in Black women’s empowerment. In addition to understanding the unique context surrounding Black women’s wellness, it is also important to understand how the current study fits into the overarching perspective about wellness within counseling psychology.
Overall, the current study addresses the gaps in the literature identified above, specifically: the need to address mental health disparities by identifying Black women’s
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wellness, the need to study wellness beyond individual PWB, the need to examine cultural models of wellness in diverse groups, the need to examine within-group differences on wellness, and the need to examine how multiple identities relate to wellness. Further clarification of the scope and aims of the current study are provided in the next section.
Purpose of the Current Study
Given the gaps in the research discussed above, the purpose of the current study is to examine a broad definition of wellness for Black women. In order to investigate this broad picture, a mixed-methods approach will used. Specifically, Black women will answer open-ended questions about their definition of wellness and the behaviors/activities that contribute to their wellness. This study also compares two models of wellness; a cultural model of wellness in Optimal Theory and an alternative model of wellness in PWB. It is important to test how individual and cultural factors impact Black women’s wellness (Perry et al., 2013). However, given the possible incongruence of PWB for people of Color in the U. S. (Constantine & Sue, 2006; Frazier,
Lee, & Steger, 2006; Daraei, 2013; Mehrotra, Tripathi & Banu, 2013), the appropriateness, fit, and utility of Ryff’s (1989) PWB for Black women will be tested.
Specifically, this study tests the factor structure of Ryff’s Scales of Psychological Well- being in a Black women sample. Additionally, this study aims to identify which dimensions of Ryff’s PWB predict mental health outcomes for Black women and to test if cultural dimensions of wellness related to Black women’s mental health outcomes above and beyond PWB. Finally, this study examines how wellness relates to Black women’s gendered-racial identity.
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The current study adds significantly to the current literature because there is a lack of understanding about what wellness means to Black women and how their gendered-racial identity influences their wellness. This knowledge will provide counseling psychologists with a greater understanding of the dimensions of wellness that are most relevant and important to Black women. In doing so, it aims to help counseling psychologists recognize models of wellness beyond individual well-being. Indeed, wellness for marginalized groups involves not just individual health, but also collective justice and liberation (Prilleltensky and Prilleltensky). By exploring the importance of cultural factors to Black women’s wellness, this study aims to help counseling psychologists recognize that wellness is unique to each person and/or cultural group and requires distribution of justice, resources, power, and opportunities at personal, relational, and collective levels (Prilleltensky & Fox, 2007).
Although this multicultural knowledge is important, it is not sufficient. If we as counseling psychologists aim to foster Black women’s wellness and decrease mental health disparities, then we must put this knowledge into action. Counseling psychologists have struggled to enact social justice in practice and research despite consistent calls to do so (Vera & Speight, 2003; Speight & Vera, 2008). The current study aims to empower counseling psychologists to be advocates for Black women by recognizing the cultural forces and identities that impact their wellness and in doing so, fostering their wellness and reducing mental health disparities.
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CHAPTER II
A REVIEW OF THE LITERATURE
This chapter will provide a background on the literature on wellness, with particular attention to unique experiences of Black women. First, the facets that influence
Black womanhood will be explored, followed by a discussion on the unique factors that define and influence Black women’s wellness and mental health symptoms. Next, two specific models of wellness will be discussed, starting with Optimal Theory (Myers 1991;
Myers & Speight, 2010) an Afro-cultural model of wellness, followed by Ryff’s model of psychological well-being (Ryff, 1989; Ryff & Keyes, 1995). The sections on both models will include a summary of the model, how it was developed, strengths and weaknesses, and research studies with racially diverse groups and Black women, specifically. Then the construct of gendered-racial identity will be reviewed, given that this study aims to understand the relationships among Black women’s wellness and identity. Finally, the rationale and hypotheses of the current study will be outlined.
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Research and practice within the field of counseling psychology is firmly rooted in a developmental, holistic, strengths-based perspective (Delgado-Romero, Lau, &
Shullman, 2012; Packard, 2009). This perspective stands in contrast to the emphasis onpathology within the overarching field of psychology. As a sub-field, counseling psychology is oriented towards facilitating individuals’ positive growth and adjustment as opposed to remediating their deficiencies and maladjustment (Delgado-Romero, Lau, &
Shullman, 2012; Lent, 2004). Our strengths-based orientation as counseling psychologists requires us to consider not only what it means when people are mentally ill, but also what it means when they are well. One way in which counseling psychologists have operationalized the consideration of people’s health is through the construct of wellness.
Wellness developed out of the positive psychology movement within counseling psychology. Positive psychology focuses on the study of positive psychological processes, such as wisdom, creativity, optimism, flow, and wellness (Seligman, 2002).
Wellness is a multifaceted construct concerning optimal experience and functioning
(Ryan & Deci, 2001, p. 142). In this way, wellness is not merely the absence of illness or dysfunction, but instead functioning as optimally as possible. Wellness considers functioning in cognitive, affective, interpersonal, and collective domains (Prilleltensky &
Fox, 2007; Prilleltensky & Prilleltensky, 2003; Ryan & Deci, 2001). Thus, wellness reflects functioning across multiple domains, whereas well-being is a narrower term used to reflect functioning within a specific domain. For instance, mental well-being reflects functioning in emotional or psychological domains (Lent, 2004; Ryff, 1989), and relational well-being reflects functioning in interpersonal domains (Prilleltensky & Fox,
2007; Prilleltensky & Prilleltensky, 2003). Types of well-being fall within, and contribute
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to, overall wellness. This study aims to understand the conceptualization of wellness that is most relevant to Black women. Prior to exploring the existing literature on Black women’s wellness and mental health, we must understand the social-cultural contexts of
Black women.
Uniqueness of Black Womanhood
Black women have a unique lived reality as a result of their gender and racial identities and the intersections among these identities (Collins, 2000; hooks, 2000;
Speight, Isom, & Thomas, 2012). Neither race nor gender can be ignored when attempting to understand Black womanhood. Indeed, the richness of Black women’s experiences lies in the intersections among race and gender. Cole (2009) defines intersectionality as an analytic approach that considers the meaning and consequences of multiple categories of social group membership. Intersectionality refers to the unique experiences people have based on the combination and overlap of their multiple cultural identities (Crenshaw, 1993).
Although measuring intersectionality is important for all research studies and all participants, it is especially important for research involving Black women (Capodilupo
& Kim, 2014; Reid & Kelly, 1994). A statement by The Combahee River Collective describes a key aspect of Black feminist work as “the development of integrated analysis and practice based upon the fact that the major systems of oppression are interlocking”
(1986, p. 1). Thus, intersectionality of identity and oppression is a key factor when understanding the lived realities of Black women (Capodilupo & Kim, 2014; Crenshaw,
1993; Cole, 2009; D’Andrea & Heckman, 2008). The current study focuses on the intersection of race and gender in the lives of Black women. However, it is important to
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note that other identities such as class, sexuality, and nationality, and other oppressive forces beyond racism and sexism, influence Black women’s experience in the world
(Collins, 2009). The focus of the current study is on the intersectionality of race and gender, while acknowledging that Black women’s experiences and identities are complex and multifaceted. Further information on how the current study utilizes an intersectional framework is discussed in this chapter in the gendered-racial identity section and the operationalization of intersectionality is discussed in Chapter 3.
As a result of the intersections of race and gender, Black women have unique experiences of identity and oppression. Traditionally, the literature on identity development ignores one aspect of identity, either race or gender, in favor of the other
(Speight et al., 2012). For instance, racial identity models tend to ignore gender, whereas gender identity models are based on the experiences of White, heterosexual women, and ignore the role of race. As a result of patriarchy, racism, and sexism, Black women continue to be ignored in identity development models (Speight et al., 2012). In response to this injustice and the lack of intersectionality in existing models, Helms developed the womanist identity model to encapsulate the identity development of women of Color
(Ossana, Helms, & Leonard, 1992). The overarching message from the womanist model is that Black women’s experiences cannot be separated into race and gender, but that their identity is simultaneously influenced by being Black and female (Speight et al.,
2012). Thus, research suggests using a gendered-racial identity model to best encompass
Black women’s identity, values, and attitudes. The gendered-racial identity model used in the current study is described in detail in the section on Sellers’ et al. (1997; 1998) model of racial identity.
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Regarding oppression, in a society that devalues both race and gender, Black women experience racism, sexism, and gendered-racism. Gendered racism is experiencing racism and sexism simultaneously, a phenomenon distinctive to women of
Color, and Black women especially (Lewis et al., 2013). Indeed, although White women experience sexism, they do not experience racism. Without an intersectional perspective, one might miss the influence of gendered-racism. Research suggests, gendered-racism significantly and uniquely predicted lower well-being and poorer mental health outcomes for Black women above and beyond sexism and racism separately (Cadilupo & Kim,
2014; Fischer & Bolton Holz, 2010; Moradi & Subich, 2003; Perry, Harp, & Oser, 2013;
Perry, Pullen, & Oser, 2012). This demonstrates that acknowledging the intersections of race and gender is essential to capturing the experiences of Black women.
In addition to gendered-racism, Black women experience oppression in the form of gendered-racial stereotypes (Collins, 2000; Speight, Isom, & Thomas, 2012). These images are socially-constructed ideas about Black womanhood and originate from slavery where Black women were oppressed based on both their race and gender identities such as by being forced to experience sexual victimization and execute stereotypically-male work (Collins, 2000). Black women experience stereotypical images based on race and gender, such as the mammy, jezebel, and sapphire (see Collin, 2000) and the strong Black woman stereotype (see Beauboeuf-Lafontant, 2009; Lewis, Mendenhall, Harwood, &
Huntt, 2013). These controlling images still exist today and serve to provide ideological justifications for the continued oppression of Black women. These stereotypes also serve to further ostracize Black women, reminding them that both their Black and female identities are devalued by society (Speight, et al., 2012).
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Before concluding this discussion on the uniqueness of Black womanhood, one caveat must be noted: although it is important to recognize the unique experiences of
Black women, it is also important not to undertake research with women of Color with the intention of “uncover[ing] atypical or nonmainstream behavior” (Reid & Kelly, 1994, p. 479). Women of Color are often neglected in research on ‘common’ female experiences such as self-esteem, body image, or sexual harassment and are the focus of research on ‘deviant’ female experiences such as teenage pregnancy, homeless women, female criminals, and welfare mothers (Reid & Kelly, 1994). The current study attempts to address this problem by focusing on wellness in Black women. Wellness is not only a more general female experience, but the construct of wellness also embodies a strengths- based perspective, thus viewing Black women “as enactors, not victims” (Reid & Kelly,
1994, p. 483). The next section discusses Black women’s wellness and mental health in depth.
Black Women’s Wellness and Mental Health Symptoms
As described above, the intersections of race and gender influence Black women’s experiences of wellness and mental health (Brown & Keith, 2003; Collins, 2000; Speight,
Blackmon, Odugu, & Steele, 2009; Speight, Isom, & Thomas, 2012). It is essential to consider the unique aspects of wellness relevant to racial and cultural groups, because what it means to be well is not universal, but rather context-dependent (Brown & Keith,
2003; Speight et al, 2009; Sue & Sue, 2008). Thus, various cultural groups have unique understandings of wellness and mental health (Christopher, 1999).
It is particularly important to consider the unique aspects of wellness for Black women, because there are significant mental health disparities in this population (Brown
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& Keither, 2003; Speight et al, 2009; Speight et al., 2012; Sue & Sue, 2008). As discussed in detail in the first chapter, Black women are 1.6 times more likely to report feelings of sadness, hopelessness, and worthlessness as compared to their White counterparts (CDC, 2012). Despite these disproportionate rates of mental illness among
Black women, they are less likely to have access to mental health treatment and psychotropic medications than White women (National Healthcare Disparities Report,
2010). The current study addresses these disparities by identifying the unique factors that define and contribute to this population’s wellness, thereby helping counseling psychologists ally in Black women’s empowerment. The following sections discuss the facets of Black women’s wellness in greater depth.
Factors that Influence Black Women’s Wellness and Distress
One factor that influences Black women’s wellness and distress is the racism, sexism, stereotypes, and other sources of oppression they experience (Brown & Keith,
2003; Cadilupo & Kim, 2014; Fischer & Bolton Holz, 2010; Moradi & Subich, 2003;
Perry, Harp, & Oser, 2013; Perry, Pullen, & Oser, 2012; Sue & Sue, 2008). One specific stereotype that impacts Black women’s wellness and distress is the Strong Black Woman stereotype. In this stereotype, Black women are portrayed as able to handle anything, put others’ needs above their own, are invulnerable to abuse, and always maintain the appearance of strength no matter what the circumstances or cost (see Beauboeuf-
Lafontant, 2009; Lewis, Mendenhall, Harwood, & Huntt, 2013). This stereotype is consistent with other portrayals of Black women as the “ultimate over-comer” for surviving slavery, enduring oppression, and anchoring their family and community
(Speight et al., 2012, p.123). Although Black women are resilient survivors, both
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historically and currently, the Strong Black Woman has been identified as a stereotype and myth because it emphasizes strength without acknowledging vulnerability, humanity, or personal needs.
Although the resiliency within the strong Black woman stereotype may serve as a coping mechanism for many Black women, this stereotype also damages their mental health and wellness (Beauboeuf-Lafontant, 2009; Donovan & West, 2015; Lewis et al.,
2013; Speight et al., 2012). For instance, embodying this ideal of strength can serve as a mask by which other aspects of Black womanhood are concealed (Beauboeuf-Lafontant,
2009; Speight et al., 2012). Oftentimes emotions are concealed, especially emotions that imply vulnerability, which does not allow for any stress reduction or emotional release.
Indeed, strong endorsement of the strong Black woman stereotype increased the likelihood of developing depressive symptoms in response to stress (Donovan & West,
2015). This stereotype also impacts Black women’s wellness through their relationships, in which they are required to maintain appearances of strength and have limited experiences of recognition and mutuality (Beauboeuf-Lafontant, 2009). Finally, over- emphasizing the strength and resiliency of Black women can also suggest that Black women do not experience mental health problems or that it is not acceptable to struggle mentally, emotionally, or interpersonally (Brown & Keith, 2003). However, as stated above, we know that Black women have higher rates of mental health issues than Black men or White women. Thus, the distress and wellness of Black women is left unacknowledged via the strong Black women stereotype. Indeed, Beauboeuf-Lafontant
(2009) suggests the real function of this stereotype is to obscure Black women’s suffering, anger, and needs.
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In addition to this stereotype, skin color and colorism impact Black women’s wellness and mental health (Keith & Thompson, 2003; Speight et al., 2012). Colorism is defined as bias based on skin tone, such as lighter-skin Blacks achieving higher salaries, occupational prestige, and educational attainment (Keith & Thompson, 2003). Colorism and skin tone impact Black women’s self-worth, feelings of attractiveness, and body image (Buchanan, Fisher, Tokar, & Yoder, 2008). Skin tone also impacts their self- esteem and self-efficacy even when controlling for the effects of social class, body image, and racial identity (Keith & Thompson, 2003). The above studies suggest that as complexion becomes darker, self-worth decreases in this population. Overall, having lighter skin tones and White physical features has social, political, and personal implications that significantly impact Black women’s self-esteem and mental health
(Brown, 2003). Thus, in order for Black women to experience mental health and wellness, it important for them to develop internal standards of beauty not based on
White ideals (Speight et al., 2012).
Another factor that influences Black women’s wellness is their attitudes and beliefs about their gender and race, or their gendered-racial identity (Brown & Keith,
2003; Constantine & Sue, 2006; Settles et al., 2010; Speight et al., 2012). The few studies that exist have yielded mixed results regarding the ability of racial or gender identity to predict Black women’s mental health (Cooper, Guthrie, Brown, & Metzger, 2011;
Littlefield, 2003; Pyant & Yanico, 1991) and psychological well-being (Miles, 1998;
Sanchez & Crocker, 2005; Yang, 2015; Woody and Green, 2015). Overall, the literature suggests that Black women have unique relationships among gender identity, racial identity, and wellness (Settles et al., 2010; Yap, Settles, & Pratt-Hyatt, 2011). Generally,
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when race is not considered, gender identity predicts wellness and mental health symptoms for Black women. However, when accounting for race, gender identity is no longer a significant predictor of wellness. To date, no study has explored the role of intersectional, gendered-racial identity on Black women’s wellness, which is a gap addressed by the current study. The section entitled ‘Racial Identity and Wellness’ further explores this literature and identifies why gendered-racial identity is a necessary construct to utilize when considering Black women’s wellness.
Overall, Black women’s mental health is impacted by gendered-racism, the strong
Black woman stereotype, skin tone, colorism, and gendered-racial identity, just to name a few sources. If they experience more mental health symptoms due to these social-cultural factors, it follows that their mental wellness could be similarly influenced. The following section identifies factors that are essential to how Black women define wellness.
Key Aspects that Define Wellness for Black Women
When considering what wellness means, there are a several components that
Black women identify as important. A few of these components are discussed below and the remainder will be discussed in the section on Optimal Theory. Research suggests spirituality and religion are key components of Black women’s wellness (Brown & Keith,
2003). Black women tend to be engaged in religious behaviors and endorse religious beliefs more so than Black men (Lincoln & Chatters, 2003). Additionally, one study found that the positive relationship between spirituality and wellness existed only for
Black participants, not White participants (Blaine & Crocker, 1995), emphasizing the potentially unique role of spirituality in the Black community.
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Black women’s spiritual beliefs predict both mental health symptoms (i.e., depression; Handal, Black-Lopez, and Moergen, 1989; Hirsch, Nsamenang, Chang, &
Kaslow, 2014; Lincoln & Chatters, 2003) and wellness (Blaine & Crocker, 1995; Boyd-
Franklin, 2010; Ellison & Taylor, 1996; Lincoln & Chatters, 2003). For instance, spiritual beliefs were positively correlated with life satisfaction and self-esteem for Black women; this relationship was even higher in women who attribute meaning in life to a Higher
Power (Blain & Crocker, 1995). Black women’s religious beliefs have also been linked to an optimistic worldview, which in turn resulted in fewer depressive symptoms (Hirsch et al., 2014). Qualitative studies also reveal that Black women view their spiritual beliefs as inexorably linked to their wellness such that their spirituality promotes health, strength, healing, and overall optimal functioning (Banks-Wallace & Parks, 2004). Thus, for the majority of Black women, wellness often involves spiritual/religious beliefs and behaviors.
Another aspect that is central to Black women’s wellness is self-definition
(Brown & Keith, 2003; Collins, 2000; Ossana, Helms & Leonard, 1992; Speight et al.,
2012). Self-definition in this context does not suggest autonomy or an individual self- construal but, rather, the freedom to define Black womanhood that acknowledges oppression and, also exists outside of oppressive constraints (Brown & Keith, 2003;
Collins, 2003; Ossana, Helms & Leonard, 1992). Brown and Keith (2003) elaborate on self-definition as a key component of Black women’s wellness. It involves defining oneself and establishing self-worth within society and relevant subgroups (e.g., people of
Color, Black people, Black women). In other words, self-definition as a part of wellness for Black women is “the clear knowledge that we are sane, that our perceptions and
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experiences are in sync…[that we know] who we are deep within our innermost being – even when the rest of the world is engaged in confusion and craziness” (Brown & Keith,
2003, p. xiv). In this way, wellness as a Black woman involves finding ways to accept oneself, validate self-worth, and develop capacities in spite of racism and sexism.
Beyond defining oneself, wellness for Black women involves awareness of and adaptation to an environment that is both racist and sexist (Brown & Keith, 2003; Speight et al., 2012). Cultural mistrust or healthy cultural paranoia (Whaley, 2001) reflects awareness of oppression. As discussed by Whaley (2001; 2004), cultural mistrust reflects
Blacks’ attitudes and beliefs about White society, including the inclination to mistrust
Whites due to historical marginalization and oppression. This behavior is often viewed as unhealthy or ‘paranoid’ to a White, dominate society, but it represents mentally healthy behavior for Black people (Whaley, 1998; Wilcox, 1973). Thus, developing vigilance about racism and sexism is a healthy coping mechanism for Black women and is an important facet of their wellness (Brown & Keith, 2003).
Wellness for Black women also involves challenging internalized racism.
Internalized racism is defined as acceptance, by marginalized groups, of negative societal beliefs about themselves (Williams & Williams-Morris, 2000), including the internalization of “distorted, false, denigrating, anti-self, anti-African messages” (Brown
& Keith, 2003, p. 24). Internalized racism, and the psychological injury and re- colonization that results from it, is potentially more damaging to mental health than overt forms of racism such as harassment or discrimination (Speight, 2007). To counteract internalized racism, Black women need to be able to “interrogate and scrutinize” racist and sexist events and expel the toxic and damaging effects such events cause (Speight et
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al., 2012, p. 127). Thus, in order for Black women to experience wellness, they must externalize the stereotypes, racist and sexist images, and societal views they have come to believe are true (Brown & Keith, 2003; Speight et al., 2012).
Overall, as a result of their gendered-racial identity and experiences of racism and sexism, Black women have factors that are essential to their wellness. Many Black women endorse religion, spirituality, and engagement in religious behaviors to be a key factor that defines what wellness means to them. Their wellness is also influenced by self-definition and the self-worth that comes along with it. Finally, in order to be well,
Black women must be aware of racist and sexist events and also able to externalize them rather than internalize such events. Taken together, these represent many of the necessary components of Black women’s wellness.
However, these factors are an insufficient understanding of what wellness means to Black women. Much more research is needed to better understand how this population defines and experiences wellness, especially research that considers their unique gendered-racial identity (Keith, 2003; Speight et al., 2012). The current study addresses this gap in the literature. Given the unique mental health of Black women, a cultural model of wellness (as compared to Eurocentric models) is best suited to explore their definition of wellness. The next section outlines the importance of using a cultural model of wellness. Following that, the cultural model used in the current study is discussed.
Cultural Models of Wellness
A cultural model of wellness takes into consideration the impact of socialization, oppression, and cultural worldview on wellness (Constantine & Sue, 2006). This stands in contrast to Eurocentric models of wellness that consider the role of individual and
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intrapsychic factors on wellness (Prilleltensky & Fox; 2007; Prilleltensky & Gonick,
1996; Prilleltensky & Prilleltensky, 2003). There has been a call for more research on wellness in racially marginalized groups using a cultural model (Constantine & Sue,
2006; Frazier, Lee, & Steger, 2006; Daraei, 2013; Mehrotra, Tripathi & Banu, 2013).
Indeed, as discussed by Myers and Speight (2010), “there remains a real need to determine the characteristics and parameters of true mental health and illness…from a culturally congruent worldview” (p. 70). The current study addresses this need by using
Optimal Theory (Myers 1988; 1991; 1993) as a cultural model of wellness (see Speight et al., 2009).
There are several reasons why it is important to use a cultural model of wellness.
First, as described above, Black women have unique experiences that influence their mental health and wellness (Brown & Keith, 2003). Thus, a cultural model of wellness is needed to understand the role of Black women’s gendered-racial experiences on wellness.
Also, different cultural values among racial groups result in different understandings of what it means to experience wellness (Christopher, 1991; Constantine and Sue, 2006).
Indeed, definitions of wellness are inextricably linked with values, and it is impossible to create a values-free definition of wellness (Compton, 2001). A cultural model incorporates Black women’s cultural values and how these values influence their definition of wellness.
Another reason it is important to use a cultural model of wellness is because the field of counseling psychology, both historically and currently, has conceptualized wellness with an over-emphasis on White cultural values. This results in understanding wellness as the result of internal capacities (Prilleltensky & Fox, 2007) and measuring
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wellness in intrapsychic, individual terms (Moradi, 2012; Prilleltensky & Prilleltensky,
2003). Indeed, the two commonly used models of well-being in the literature, Ryff’s
Psychological Well-Being and Deiner’s Subjective Well-Being, define and measure wellness in individualistic terms (see Yoder et al., 2012).
Defining wellness in individualistic terms ignores the multiple sources of oppression (e.g., intrapersonal, relational, collective, political) experienced by marginalized groups (Prilleltensky & Fox, 2007; Prilleltensky & Gonick, 1996;
Prilleltensky & Prilleltensky, 2003). Oppression from all sources, not just individual- level oppression, impacts the wellness of racially diverse groups (Lee & Ahn, 2011,
2012; Sellers, Copeland-Linder, Martin, & Lewis, 2006; Pieterse, Todd, Neville &
Carter; 2012). Indeed, one study found that individual and societal stressors had an equal impact on the wellness of Black women (Perry et al., 2013). Thus, in order to develop a broad picture of Black women’s wellness, we must view individual, psychological well- being as only one component of overall wellness. We need to expand our conceptualization of wellness to include cultural, societal, relational, and collective influences by using a cultural model.
Additionally, Prilleltensky and Prilleltensky (2003) state that defining wellness solely in terms of the individual “conjures images of people enjoying life, worry free, and healthy” (p. 276) while ignoring the fact that oppressed groups need to experience justice and liberation in order to be well. Wellness and justice/liberation are inseparable; wellness cannot exist in the presence of inequality and injustice (Prilleltensky & Fox
2007; Prilleltensky & Prilleltensky, 2003). As a result, in order to experience wellness, people must experience liberation to be empowered and liberation from injustice and
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oppression. Liberation and empowerment on individual, relational, and collective levels are especially relevant for Black women’s wellness (Ali & Levy, 2012; Brown & Keith,
2003; Collins, 2000; Crocker, Luhtanen, Blaine, & Broadnax, 1994; Enns & Discher,
2012; hooks, 2000; Mokgatlhe & Schoeman, 1998). Thus, in order to understand the wellness of Black women, we must not only understand the extent to which they experience well-being, but also the extent to which they experience empowerment and liberation. A cultural model of wellness best encompasses this balance between wellness and liberation, and between individual and collective.
Given the importance of using a cultural model of wellness, there are a variety of models that exist for understanding the wellness Black people (Speight et al., 2009; Sue
& Sue, 2008). Speight et al. (2009) discuss several of these models. Racism/Stress models of well-being emphasize the role of racism in restricting mobility, increasing stress, and internalizing racist beliefs about oneself (Speight et al., 2009). As a result, this model articulates that Black people’s wellness is dependent on their ability to successfully manage racism. Another model, the Africentric Model, emphasizes the internalization of African principles (e.g. cooperation, interdependence, collective responsibility) and externalization of Eurocentric principles (e.g. competition, individualism, and control over one’s environment; Speight et al., 2009). Thus, wellness according to this model is defined as embracing an African identity and grounding oneself in African principles. Another type of cultural model integrates aspects of the
Racism/Stress and Africentric Models (Speight et al., 2009). Such a model would define wellness as navigating racism while moving towards an integrated African cultural identity.
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Overall, these cultural models of wellness offer a more nuanced and culturally- informed perspective of wellness compared to Eurocentric models. They address the contemporary barriers to mental health and historical resilience of African cultures, people, and principles. Together, the above cultural models articulate that wellness for
Black people means developing a racially positive identity based in African cultural values and negotiating oppression with flexibility, creativity, and adaptability (Speight et al., 2009). Eurocentric models based in White values neglect these necessary components of Black people’s wellness. However, the use of cultural models of wellness continues to be underutilized in the psychological literature (Constantine & Sue, 2006; Prilleltensky and Prilleltensky, 2003; Speight et al., 2009).
Despite the improvement cultural models offer over Eurocentric models of wellness, they do have limitations. First, these models assume that all African/Black people share the same cultural origin or ethnicity (Speight et al., 2009). In reality, there is immense variation among African ethnic groups and it is wrong to assume that all people with African heritage inherited the same cultural values. The difference between cultural similarity and cultural uniformity is key; cultural similarity acknowledges the common values within traditional African cultures, whereas cultural uniformity assumes that all people of African heritage have the same cultural values (Speight et al., 2009). It is appropriate, and necessary, to use the cultural similarity perspective when acknowledging core values of wellness within Black people. The models discussed above fail to take this cultural similarity perspective, and instead assume cultural uniformity.
Another limitation of the above cultural models is the lack of acknowledgment of within-group differences (Myers et al., 1991; Speight et al., 2009). The models
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emphasize race, but disregard within-group differences based on gender or sexuality.
Although it is important to focus on racial aspects of wellness, the exclusion of other identities oversimplifies the wellness of marginalized groups. As discussed above, Black women’s wellness requires an examination of both their gender and racial identities.
Thus, the cultural models above fail to make sufficient allowances for intersectionality, which is an essential feature of Black women’s wellness (Speight et al., 2009).
Myers et al. (1991) further identifies the limitations of these cultural models of wellness. She discussed that many of the cultural models of wellness were developed out of a reaction to cultural events, such as the civil rights movement. The authors state that many models were not developed systematically out of theory. As a result, Myers et al.
(1991) argue that current cultural models may be more relevant to a particular time period and lack universal principles of wellness.
As a systematically derived, intersectional, and culturally-inclusive model of wellness, Optimal Theory (Myers, 1988; 1991; 1993) addresses the limitations discussed above. The next section discusses Optimal Theory in depth, including its development, strengths, limitations, assumptions, and applications as a cultural model of wellness in the current study. The empirical research on Optimal Theory will be discussed at the end of the next section.
Optimal Theory
This section provides an overview of Optimal Theory, which is the cultural model of wellness in the current study. First, I discuss the historical context and development of the theory. Next, I identify the dimensions that define wellness, or an optimal worldview.
Then I outline the theoretical assumptions and discuss the application of Optimal Theory
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to Black women. Following this, I discuss the strengths and limitations of the theory and end this section by reviewing the extant literature on optimal theory, wellness, and mental health.
Optimal theory was developed by Dr. Linda James Myers (1988; 1991; 1993). At the broadest level, she developed her theory out of African philosophy, which is a system of psychological analyses and applications centered on African realities, cultures, and epistemologies (Parham, White, & Ajamu, 1999). She drew upon the works of historical and contemporary writers of African culture such as Asante, Akbar, Nobles, Obasi,
Hurley Woodson, and Mbiti (see Myers, 1993; Myers & Speight, 2010). She explored the principles outlined by these writers, identifying the core beliefs of African consciousness and core aspects of a good life according to African philosophy. The themes she discovered serve as the dimensions of wellness and optimal functioning in her model.
Her goal was not to recreate African culture in terms of rituals, specific practices, or beliefs; rather she wanted to identify a worldview that results in wellness and exists across cultures and time (Myers, 1993).
In developing her model Myers also drew upon the philosophical beliefs and writings of other racial-cultural groups. She explored the worldviews of Native
Americans and Eastern philosophers, utilizing their beliefs about life, humanity, and wellness as influential forces in developing her theory (see Myers, 1993; Myers et al.,
1991). In this way, Myers (1993) emphasizes that her theory is not exclusively African and was not intended to be. By drawing upon the belief systems of African people and other racial-cultural groups, Optimal theory is multifaceted and holistic. Another influential force in the development of Optimal theory was her own experiences as a
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Black woman. Myers (1993) discusses how she began a process of self-exploration, identifying a worldview that is both Afrocentric and feminine. She also unpacked her experiences of racism and sexism to understand the mentality behind oppression and a sub-optimal worldview. This desire to understand wellness, her own experiences of racism and sexism, and the worldview that undergirds both wellness and oppression, was key to the development of her model (Myers, 1993).
There are some key theoretical assumptions within Optimal Theory. First, Myers
(1993) postulates that our conceptual system (e.g. optimal/suboptimal) is developed through socialization. Thus, the beliefs we use to navigate the world do not appear out of thin air, but are socially constructed and passed down to us through socialization (Myers,
1991, 1993; Myers et al., 1991; Myers & Speight, 2010). However, she does not explain the mechanisms of this socialization, which is a limitation of her theory. Another key assumption within Optimal Theory is that the definitions of wellness and illness
(discussed below) are universal (Myers, 1993). In other words, while the optimal conceptual system developed out of Africa, the theory is not limited to African/Black people. Rather, the conceptualization of wellness in Optimal Theory applies to all people and all cultures. As stated by Myers (1993), although some cultures better represent optimal functioning/wellness (e.g. Afrocentric) and some cultures better represent suboptimal functioning/illness (e.g. Eurocentric), all individuals are capable of optimal and/or suboptimal beliefs. More specifically, White people are capable of optimal beliefs, and Black people are capable of suboptimal beliefs.
Overall, optimal theory posits that true wellness results from transcending one’s own belief system, thereby gaining a deeper appreciation of one’s culture and respect for
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other cultures (Myers, 1993). Thus, each person is able to consciously choose which way of thinking to identify with (e.g. optimal or suboptimal), recognizing that one creates wellness and the other distress. The next section discusses the dimensions of an optimal and suboptimal worldview and how each relates to wellness.
Optimal versus Suboptimal Worldview: Links to Wellness
According to Myers (1988, 1991, 1993) each person has a conceptual system, or a set of philosophical assumptions and principles upon which they rely. Our assumptions, beliefs, and principles influence how we experience life, and depending on what we beliefs we espouse, help us to experience wellness or illness. Optimal theory postulates that a particular set of beliefs serve to facilitate and define wellness, and are thus called the optimal worldview. In contrast, the set of beliefs within the suboptimal worldview serve to facilitate and define illness. Myers’ explanation of how our conceptual system influences wellness/illness will be explained after first identifying the components of both the optimal and suboptimal belief system (see Table 1). The following dimensions make up an optimal belief system: self-knowledge, holistic worldview, diunital logic, extended self identity, intrinsic self worth, spiritual sense of reality, and valuing interpersonal relationships.
As described by Myers (1993), self-knowledge is a process of gaining a deeper understanding of self and increasingly relying on inner knowledge. Self-knowledge includes knowing about one’s true identities, experiencing intuition of a deeper sense of self, and using this knowledge as the basis of understanding the world. A holistic worldview recognizes the interrelatedness and interdependence of all things, people, and
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experiences. This holism allows us to recognize a sense of connection among our daily experiences and experience a greater purpose for ourselves, others, and nature.
Table 1
Comparison of Optimal and Suboptimal Worldview
Optimal Suboptimal
Worldview Holistic Segmented (duality)
Ontology Reality is material and Reality is material spiritual (known (known through five through sensory and senses only) extrasensory ways)
Values Interpersonal Acquiring objects relationships Cooperation Competition Communalism Individualism Harmony with nature Control of nature
Logic Diunital (both/and) Dichotomous (either/or)
Identity Extended self Individual self
Acquisition Through intuition and Through counting and of self-awareness measuring knowledge
Sense of Intrinsic in being Based on external worth criteria Note. Table was adopted from Montgomery, et al., 1990; Myers et al. 1996
Another aspect of the optimal worldview is diunital logic, or the ability to balance good and bad, to hold a both/and perspective rather than an either/or perspective. This is evident in the lives of Black women who experience wellness by believing they are both a good person and society says they are unworthy. Extended self-identity is a sense of self that includes ancestors, the yet unborn, all of nature, and the entire community. In this
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way, experiences are understood through connectedness and not from an individual view.
Intrinsic self-worth reflects awareness of a Divine purpose within us and belief that we are worthy simply by being born and we do not need to earn our worth. The optimal worldview also involves a spiritual sense of reality, or recognizing that the world is both material and spiritual. By recognizing the spiritual and material nature of reality, we lose sense of ourselves as just individuals and connect to a life force and identity beyond ourselves. Lastly, wellness means valuing interpersonal relationships, including connection, communalism, and harmony with others and nature. Overall, the optimal worldview according to Optimal Theory involves conscious efforts to grow, deepen self- knowledge, and recognize our connection to others, ancestors, Spirit, nature, and future generations (Myers & Speight, 2010).
In contrast to the optimal worldview is the sub-optimal worldview, which represents illness, dysfunction, and lack of wellness. The dimensions of suboptimal beliefs are: materialistic/external knowledge, segmented worldview, dichotomous logic, individual self-identity, extrinsic self-worth, material sense of reality, and valuing objects/material goods (Myers, 1993). First, the suboptimal worldview relies on materialistic/external knowledge, which is a way of understanding the world through objective methods such as counting and measuring. Another dimension is a segmented worldview in which the separation of mind/body, material/spiritual, and self/others is endorsed. Relatedly, the suboptimal worldview also endorses dichotomous logic, or either/or thinking. For instance, a person believes they are good or society says they are bad, but both cannot be true. The suboptimal worldview endorses an individual self- identity, or defining oneself in terms of who one is an individual, separate from
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community, relationships, or ancestors. Also self-worth is extrinsic, meaning our worth as humans is defined on external criteria such as accomplishments, possessions, looks, and education. The suboptimal view has a material sense of reality, where it is believed we can only have knowledge through objective ways and the five senses. These sources are considered to be ‘real’, whereas the spiritual and extrasensory aspects of reality are not.
Finally, rather than valuing interpersonal relationships, the suboptimal worldview values objects/material goods. This includes valuing the acquisition of objects, competition, individualism, and control over others and nature. Overall, the suboptimal worldview according to optimal theory involves efforts to gain material goods, deepen objective knowledge, and gain control over self, others, and nature (Myers & Speight, 2010).
Myers (1998, 1991, 1993) and Myers and Speight (2010) describe how the optimal and suboptimal worldview facilitate wellness and illness, respectively. Because most of our beliefs operate on an unconscious level, the first step towards wellness is gaining consciousness of the worldview, or conceptual system, we utilize. With awareness of our conceptual system we have the power to define our reality, or how we understand, internalize, and respond to experiences (Myers, 1991; 1993; Myers &
Speight, 2010). For instance, the optimal system acknowledges the power to define reality is inherent within ourselves and our Spiritual essence; the suboptimal system relinquishes the power to define reality to other people, material goods, and external factors (Myers, 1993). Although we may not have control over what happens to us, we can control the beliefs we use to define ourselves and understand our reality (Myers &
Speight, 2010). Choosing consciously within the optimal system leads to wellness,
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whereas allowing dominant society to choose for us within the suboptimal system leads to distress.
More specifically, the optimal worldview leads to wellness (Myers, 1988, 1991,
1993). By adhering to the principles of the optimal conceptual system our consciousness is focused on living moment to moment, adapting to relationships, and connecting to our larger purpose. Thus, we experience internal consistency and from this core sense of self we navigate our environment with flexibility and openness (Myers, 1991). Given that the optimal worldview is holistic, we are able to evaluate all events and embrace all aspects of ourselves, becoming “one with the source of all good and that higher spiritual source as the controller of our well-being” (Myers, 1991, p. 14). Rather than straining to establish our worth based on material goods, the optimal belief system frees us to pursue that which brings about our growth, truth, justice, and worth. Thus, the optimal worldview allows us to experience wellness, and beyond that, liberation, within our relationships, the world, and ourselves.
In contrast to the optimal worldview and wellness, the suboptimal worldview leads to illness (Myers, 1988, 1991, 1993). At its core, the suboptimal worldview is based on the principle that only material goods are necessary for functioning. Emphasizing material goods sets us up for scarcity and competition because material goods are finite.
Also, when we define our worth on material goods and external criteria we create a sense of self that is fragile (e.g. I am only as good as what I own). We resort to searching for more and more goods to help us function in life and define our worth until “we are left feeling insecure, anxious, depressed, and looking outside ourselves for something else to make everything better” (Myers, 1993, p. 10).
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The suboptimal worldview not only results in illness within individuals, but also illness in society. As described by Myers and Speight (2010), suboptimal beliefs result in a sense of self that is disconnected from its moral compass and connectedness to others.
This fuels the creation of biased policies, laws, and institutional practices. For instance, by orienting humans towards external criteria as the source of their worth, material things like White skin and male sex characteristics make people more worthy and they get more of the limited material goods so valued in the suboptimal system (Myers, 1993; Myers et al., 1991). In this way, oppression is a natural consequence of the individualism, materialism, and competition of the suboptimal worldview (Myers, 1993). Because our worldviews often operate at an unconscious level, those in power are often unaware of how their suboptimal beliefs create and uphold oppression, making the destruction of hegemony that much more insidious (Myers, 1991). Indeed, the prevailing, suboptimal worldview in US society often goes unexamined and unchallenged (Myers & Speight,
2010) and is celebrated and encoded in societal policies and practices.
Overall, experiences of wellness or illness lie in our ability to define reality based on beliefs of connectedness, openness, and flexibility (optimal/wellness) or with beliefs of individualism, control, and rigidity (suboptimal/illness). The beliefs we endorse will be the key to our wellness-liberation or to our entrapment in oppression (Myers, 1991;
Myers & Speight, 2010). The next section discusses how the tenets of Optimal Theory apply to Black women’s wellness.
Optimal Theory and Black Women’s Wellness
Optimal Theory (Myers, 1988, 1991, 1993) holds great promise as a model to define and understand Black women’s wellness. Overall, wellness within Optimal Theory
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is the process of becoming aware of one’s conceptual system, externalizing suboptimal views, and making intentional choices to define reality from an optimal worldview. This reflects the process of challenging internalized racism and coping flexibly in a gendered- racial environment, both of which are important for Black women’s wellness (Brown &
Keith, 2003; Speight, 2007; Speight et al., 2012; Williams & Williams-Morris, 2000).
Myers’ theory acknowledges the importance of socialization, emotions/intuition, and cultural values on wellness. Watt (2003) discusses how these domains are neglected in other models of wellness (even cultural models) and are especially important for Black women’s mental health. Additionally, Optimal Theory provides an understanding of how wellness is linked to empowerment and liberation. As discussed earlier, in order to experience wellness, Black women must also experience liberation and freedom from injustice (Prilleltensky & Fox 2007; Prilleltensky & Prilleltensky, 2003).
The specific dimensions of the optimal worldview also align with Black women’s wellness. First, the optimal worldview acknowledges that reality is both material and spiritual in nature. As discussed earlier, spirituality and religion are key factors of wellness for Black women (Blaine & Crocker, 1995; Boyd-Franklin, 2010; Brown &
Keith, 2003; Hirsch, Nsamenang, Chang, & Kaslow, 2014; Lincoln & Chatters, 2003).
Additionally, Myers’ definition of wellness incorporates an extended self-identity and values of relationships, interconnectedness, and harmony. As discussed earlier, relationships are an important aspect to Black women’s wellness (Arce, 2005; Brown &
Keith, 2003; Schmidt et al., 2014; Speight et al., 2012). Finally, Myers’ self-knowledge dimension aligns with self-definition, which was discussed earlier as an important aspect to Black women’s wellness (Brown & Keith, 2003; Collins, 2000; Ossana, Helms &
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Leonard, 1992; Speight et al., 2012). Many of the dimensions of an optimal worldview are highly relatable to how Black women define wellness.
Thus, Optimal Theory has significant potential to conceptualize Black women’s wellness in light of the unique gendered-racial factors discussed earlier in this chapter.
This is a significant strength of Optimal Theory compared to other models of wellness, even other cultural models. Other strengths of Optimal Theory include allowing for within group differences and acknowledging multiple identities/intersectionality.
Additionally, Myers’ theory is one of a few models of wellness that provides a definition of illness or dysfunction. This is important because by understanding what distress is and the beliefs that contribute to it, we better understand wellness (Myers, 1993). Myers’ theory also accounts for oppression and liberation, essential components to the wellness of marginalized groups, especially Black women (Brown & Keith, 2003; Speight et al.,
2012). Another strength of Optimal Theory is that it goes beyond identifying what wellness is to offering a process for how to create and sustain wellness (Myers & Speight,
2010). Unlike other theories of wellness that focus on a person’s temporal attitudes towards life events, the current theory outlines the sustainable principles that guide our life. This results in a more complex definition of wellness and how to foster it in society and ourselves.
In addition to strengths, Optimal Theory also has limitations. First, the theory states that our worldview develops out of socialization but the mechanisms of this process are not articulated. Thus, it remains unclear how Myers believes all people are able to develop an optimal worldview even if they experienced different socialization processes. Another limitation of this theory is that is lacks an explanation for how people
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raise their consciousness. Myers (1993) states that gaining conscious awareness of one’s worldview is necessary for wellness; but the process by which this occurs is not described. Relatedly, the theory does not discuss the mechanisms by which people can externalize the suboptimal beliefs they have internalized. Additionally, Myers fails to acknowledge how the optimal worldview could possibly lead to distress. It is possible that if someone lacks sufficient critical consciousness the benefits of harmony, humbleness, and civility within the optimal worldview can result in reluctance to stand up to oppression and internalization of society’s degrading beliefs (Myers & Speight, 2010).
However, Myers and colleagues do not discuss fully these (and other) possible consequences of optimal beliefs. A final limitation of Optimal Theory is that it has limited use in research, with few studies using its’ tenets as a definition of wellness.
However, this is could be due to researcher bias towards Eurocentric models of wellness.
The next section discusses studies that have explored wellness and mental health symptoms using Optimal Theory.
Research on Optimal Theory and Wellness
Despite the potential applications of Optimal Theory, it has not yet been empirically tested as a model of wellness for Black women. To date, most studies test
Optimal Theory with White and Black students or with Black men and women (e.g.
Hatter & Ottens, 1998; Montgomery, Fine, & James-Myers, 1990; Neblett & Carter,
2012; Neblett, Hammond, Seaton, & Townsend, 2010). Thus, the nuisances of intersectionality within Black women’s wellness remain unexplored.
In the limited research that does exist, endorsement of an optimal worldview is linked with physical health benefits (Neblett & Carter, 2012), fewer mental health
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symptoms (Neblett, et al., 2010), and improved adjustment to school (Ewing, Richardson,
James-Myers, & Russell, 1996; Hatter & Ottens, 1998). The above studies used the
Belief Systems Analysis Scale (BSAS; Montgomery et al., 1990), which is the corresponding measure for Optimal Theory and captures the extent to which a person endorses optimal beliefs. For instance, Neblett and Carter (2012) found that endorsement of optimal beliefs moderated the relationship between racist events and blood pressure for
Black young adults (n = 210). In other words, racist events led to high blood pressure for people who with fewer optimal beliefs, but those with moderate and high optimal beliefs did not experience any change to their blood pressure as a result of racist events.
However, Neblett and Carter (2012) only used the intrinsic self-worth dimension and did not include the other aspects of wellness/optimal beliefs. Thus, more research is needed on the full model of Optimal Theory.
Two studies tested the full Optimal Theory as it relates to college adjustment.
Both studies used the BSAS to measure wellness/optimal beliefs and various measures of college adjustment (e.g. academic self-concept, emotional adjustment). Overall, these studies found that Black students with more optimal beliefs had better adjustment (Ewing et al., 1996; Hatter & Ottens, 1998). Specifically, Black men and women graduate students (n = 103) with more optimal beliefs were less likely to experience the imposter syndrome (e.g. feeling inadequate in graduate school; r = -.35, p < .05; Ewing et al.,
1996). Ewing and colleagues (1996) also used a regression model including optimal beliefs and racial identity to predict college adjustment. An optimal worldview was the only significant predictor of adjustment and it predicted adjustment above and beyond
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racial identity. Thus, optimal beliefs not only resulted in better wellness and functioning, but they were uniquely predictive of Black graduate students’ positive adjustment.
Relatedly, Hatter and Ottens (1998) tested the endorsement of optimal beliefs on
Black men and women students’ adjustment to a predominately White university (n =
67). Overall, there was a strong positive relationship between an optimal worldview to overall adjustment (r = .51, p = .0001). Optimal beliefs were also strongly related to better emotional adjustment (r freshman/sophomore = .59, p = .0001; r junior/senior =
.61, p = .001). Thus, Hatter and Ottens (1998) demonstrate that the more that Black students endorsed an optimal conceptual system the more they experienced wellness.
Both studies provide support for how optimal beliefs are linked with better emotional functioning (Ewing et al., 1996; Hatter & Ottens, 1998). Thus, Myers’ (1993) dimensions likely represent wellness for Black students.
The findings of Neblett, Hammond, Seaton, and Townsend (2010) further support the importance of optimal beliefs to the wellness of Black people. They used a sample of
Black women and men college students attending a primarily White university (n = 112) and measured wellness/optimal beliefs using the BSAS. Overall, a more optimal worldview resulted in less stress (r = -.31, p = .01) and fewer depressive symptoms (r = -
.37, p = .01). Again, Myers’ principles are likely to represent wellness for this population.
More specifically, Neblett et al. (2010) tested how the development of depression in response to stressful events was buffered by an optimal worldview. For Black men and women, endorsement of optimal beliefs moderated this relationship, meaning that participants with fewer optimal beliefs were more likely to develop depression in response to stress. In contrast, participants with more optimal beliefs were less likely to
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develop depression even though they had the same level of stress as the suboptimal group. The results of Neblett and colleagues (2010) suggest Myers’ optimal beliefs are linked with the development of mental health symptoms for Black men and women.
A study by Watt (2003) demonstrates the use of Optimal Theory with Black women. To the best of the author’s knowledge this is the only study examining Optimal
Theory with Black women, specifically. Watt (2003) conducted four focus groups with
Black women (n = 48) exploring their identity development and the role of spirituality in their mental health and coping. Watt (2003) found several areas of overlap between
Optimal Theory and themes derived from her focus groups. First, participants discussed how developing of self-awareness and critical consciousness was essential to their mental health (e.g. Myers’ (1991) self-knowledge). Participants also identified reliance on relationships and a Higher Power as important to their health and necessary for resisting negative societal messages (e.g. Myers’ (1991) spiritual nature of reality, diunital logic, and extended self-identity). Finally, Watt’s (2003) participants discussed having fewer mental health symptoms as their identity moved from a fragmented sense of self to an interconnected/holistic sense of self (e.g. Myer’s (1991) holistic worldview and extended self-identity). Overall, Watt (2003) provides support for using Optimal Theory to understand Black women’s wellness, identity, and mental health symptoms.
The above review sets a precedent for using Optimal Theory as a definition of wellness for Black people. All of the studies found that optimal beliefs led to improved functioning and emotional health for Black men and women. However with the exception of Watt (2003), all of the above studies failed to recognize within-group differences and the influence of identity development on wellness. The current study addresses these two
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gaps in the literature by first, exploring Optimal Theory within a sample of Black women and second, exploring how their gendered-racial identity relates to wellness.
Furthermore, the above studies did not address if Optimal Theory had improved predictive ability above and beyond alternative models of wellness. Given the emphasis on empirical, objective knowledge within psychology (Myers, 1991), some psychologists might need empirical results in order to believe that a cultural model of wellness is a better fit for Black women’s wellness compared to other wellness models. The current study address this gap by testing two models of wellness, Optimal Theory as a cultural model of wellness and Ryff’s Psychological Well-being ((Ryff 1989; Ryff & Keyes,
1995) as an alternative, Eurocentric model of wellness. The next section discusses alternative models to wellness, focusing on Ryff’s (1989) model.
Alternative Models of Wellness
There are several benefits to testing an alternative model of wellness in addition to testing a cultural model. First, by using dimensions from two models of wellness it is more likely that this study can capture a holistic, comprehensive, and broad definition of
Black women’s wellness. Also, given that this study is testing how wellness relates to gendered-racial identity, it is important to consider dimensions of wellness that may be appropriate to various identity statuses. For instance, a Black woman whose race is less central to her self-concept may find an alternative model of wellness as more relevant to her identity than a cultural model of wellness. Thus, by comparing two models of wellness Black women have more options to choose from when it comes to which dimensions of wellness are most important to their gendered-racial identity. A final benefit to testing two models of wellness is being able to speak to the appropriateness of
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each model for Black women. This study hopes to contribute to the literature on which model(s) of wellness (and dimensions within each model) are most culturally-congruent for this population. Testing two models could give support for the potential benefits of using a cultural model of wellness over alternative models.
When looking at models of wellness beyond cultural models, there are two distinct philosophical perspectives: hedonic and eudaimonic (Lent, 2004; Ryan & Deci,
2001). These two perspectives hold distinct views of what constitutes a good life and a good society (Ryan & Deci, 2001). The hedonic perspective holds that mental/emotional health consists of pleasure or happiness (Lent, 2004). The hedonic viewpoint relates most closely with subjective well-being, a construct championed by Ed Diener (Lent, 2004).
Subjective well-being (SWB) consists of life satisfaction, the presence of positive mood, and the absence of negative mood (Ryan & Deci, 2001).
In contrast, the eudaimonic perspective suggests that mental/emotional health is not just “feeling good”, but growing psychologically, making meaning of life, and seeking out purpose (Lent, 2004; Ryan & Deci, 2001; Waterman, 1993). The eudaimonic perspective is best represented by psychological well-being (PWB). Psychological well- being postulates that people experience wellness when their activities provide their life with meaning, growth, and purpose (Waterman, 1993). If SWB is striving for satisfaction and pleasure, PWB is striving for a life that represents the actualization of one’s true potential.
There has been a historical debate between hedonic and eudaimonic perspectives, and subjective and psychological well-being, a debate that continues into the current body of literature (see Ryan & Deci, 2001). One aspect of this debate has been the
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conceptual and empirical distinctiveness between SWB and PWB. Several authors have tested the overlap between these two constructs (Burns & Machin, 2009, 2010; Compton,
Smith Cornish, & Qualls, 1996; Keyes, Shmotkin, & Ryff, 2002; Gallagher, Lopez, &
Preacher, 2009; McGregor & Little, 1998; Ryff & Keyes, 1995). Most recently, Chen,
Jing, Hayes, and Lee (2013) used a bifactor model to examine the uniqueness of each type of well-being and conclude that SWB and PWB are strongly related at a general construct level, yet once this overlap is parceled out, the individual components of each well-being are distinct. Their results are consistent with factor analysis and regression studies that found a moderate to strong correlation between the two types well-being, yet significant enough differentiation and unique factors that SWB and PWB can be considered distinct constructs (Burns & Machin, 2009, 2010; Compton et al., 1996;
Keyes et al., 2002).
PWB has strengths beyond SWB that suggest it is the more appropriate construct for the current study. First, the construct of PWB offers unique prediction of wellness above and beyond SWB (Burns and Machin, 2010). Second, it is important to study PWB because of the temporal stability it offers beyond SWB. SWB is theorized to fluctuate with daily life experiences whereas PWB is theorized to be a stable construct (Burns &
Machin, 2009; 2010; Headey & Wearing, 1991, p. 56, Kokko, et al., 2013). Research supports PWB as a stable predictor of wellness (Kokko, Korkalainen, Lyyra, & Feldt,
2013; Springer, Pudrovska, & Hause, 2011). Another strength of PWB is that it is offers a more multifaceted conceptualization of wellness compared to SWB and better captures human functioning by acknowledging the complex interactions of self, others, and environment that lead to purpose, growth, and quality of life (Ryff, 1989; Ryff & Keyes,
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1995; Ryff & Singer, 1998). Thus, SWB is a limited descriptor of overall and long-term positive functioning, whereas PWB offers a robust and stable indictor of healthy living.
Unfortunately, despite its more comprehensive nature, PWB remains under-researched, leading to a gap in the wellness literature (Lent, 2004; Mehrotra, Tripathi, & Banu, 2013;
Ryff & Singer, 1998). The current literature is saturated with models of SWB and more research on PWB is needed (Burns & Machin, 2009, 2010; Ryff, 1989).
There have been a few iterations of PWB, beginning with Bradburn’s (1969) seminal work exploring the distinctions between positive and negative affect and the role of meaning and happiness in balancing these two emotion states. Other definitions of
PWB include McGregor and Little’s (1998) clarity of life goals and Ryan and Frederick’s
(1997) vitality and feeling energized. More recently, Ryan and Deci’s (2000) self- determination theory, which emphasizes self-actualization and the meeting of three psychological needs (autonomy, competence, and relatedness), has been offered as another conceptualization of PWB. A final iteration of well-being is Carol Ryff’s (1989;
Ryff & Keyes, 1995) multidimensional model of PWB. Ryff’s model is the most well- known and commonly used model of psychological wellness (Ryff, 1989; Ryff & Keyes,
1995). As discussed in the next section, Ryff’s model has many advantages compared to these other models of PWB.
Ryff’s Psychological Well-being Model
This section provides an overview of Ryff’s model of PWB (Ryff 1989; Ryff &
Keyes, 1995). In the current study Ryff’s (1989) PWB is used as an alternative model of wellness compared to Optimal Theory (Myers, 1991). This section begins by discussing how Ryff developed her model of PWB, outlining the key assumptions and strengths, and
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reviewing the dimensions of PWB. Following this, I review the extant literature on PWB, wellness, and mental health symptoms. To conclude I discuss the application of Ryff’s
(1989) PWB to diverse groups, and Black women specifically, and provide a rationale for including Ryff’s model despite its limitations.
In 1989, Ryff published her multidimensional model of PWB, along with an instrument called the Scales of Psychological Well-Being. To develop her model she drew heavily upon theory, in contrast to the atheoretical nature of the wellness literature at the time (Ryff, 1989; Ryff & Keyes, 1995). Thus, the fact that her model is derived from theory is a strength. She drew upon several theories, including Erikson’s psychosocial stages, Allport’s concept of a mature personality, Roger’s fully-functioning person, Jung’s account of individuation, and Maslow’s idea of self-actualization (Burns
& Machin, 2009; Ryff & Keyes, 1995). Ryff analyzed each theory for what it identified as the essence of positive psychological functioning (see Ryff & Singer, 1998). In doing so, she found many overlapping features of positive functioning, which served as points of convergence for her dimensions of PWB (Strauser, Lustig, & Çiftçi, 2008, p. 22).
In addition to using theory to establish her dimensions of PWB, Ryff had several theoretical assumptions that influenced the development of her model (Ryff & Singer,
1998). Her philosophical assumptions are outlined in Ryff and Singer (1998) and are summarized here. One assumption is that it is important to define positive functioning beyond merely the absence of illness. She also emphasizes that PWB is not just positive emotions, or having “momentary pleasures,” but rather a “whole life” made up of many
“splendors” that impact people in deep and purposeful ways (p. 3). Additionally, Ryff held the belief that human life and wellness is not reducible to single factors, thus laying
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the groundwork for a multidimensional model of wellness. The comprehensive and multidimensional nature of Ryff’s (1989) model is a unique strength, and a key reason why her model is the most widely used theory and measure of PWB (Lent, 2004). Indeed, a series of factor analysis studies discussed in Ryff (1989) support the uniqueness of her model compared to other measures of PWB. Another strength of her model is that she goes beyond variables that exist within individuals, such as life goals, vitality, or psychological needs and includes variables that capture an individual’s interactions with other people (e.g., positive relations with others) and their environment (e.g., environmental mastery).
Tying together all her core assumptions, along with aspects of positive functioning she derived from theory, Ryff rationally derived the following six components of PWB: autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, and self-acceptance. These dimensions of wellness are discussed next.
Dimensions of Psychological Wellness
The following dimensions define psychological wellness according to Ryff
(1989): autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, and self-acceptance (see Table 2). Autonomy reflects a person’s ability to resist social pressures, regulate his or her own behavior, and evaluate him- or herself according to personal standards (Ryff & Keyes, 1995). Environmental mastery includes managing a range of external activities, making effective use of surrounding opportunities, and choosing contexts that meet personal needs or values. In contrast to a person with high mastery, a person with low mastery has difficulty managing everyday
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affairs and feels unable to change or improve his or her context, including feeling unable to control the external world.
Table 2
Comparison of High and Low Psychological Wellbeing (PWB)
High PWB Low PWB
Self- Positive attitudes Dissatisfied with self; acceptance towards self; sees both trouble about certain bad and good qualities qualities
Positive Warm, safe, trusting Few close trusting relations with relationships with relationships, isolated others others
Autonomy Self-determined, Focused on independent, able to expectations and resist social pressures evaluations of others, conforms to social pressures
Environmental Competently manages Difficulty managing Mastery affairs, finds everyday affairs, unable opportunities in to change surroundings surroundings
Purpose in life Has goals, Lacks goals, direction, directedness, beliefs and beliefs that give that give meaning meaning
Personal Continued Personal stagnation, growth development, open to feels bored or new experiences uninterested in life Note. Table was adopted from Ryff & Keyes (1995)
The next dimension, personal growth, captures the feeling of continued development, openness to new experiences, sensing improvement in self and behavior over time, and changing in ways that reflect more self-knowledge. Another dimension is positive relations with others, which reflects the experience of satisfying and trusting
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relationships with others. Purpose in life is a sense of directedness, including aims and objectives for living, holding beliefs that give life meaning, and finding meaning in present and past life. Finally, self-acceptance is holding a positive attitude towards oneself, as well as acknowledging and accepting multiple aspects of the self (both positive and negative qualities). Overall, wellness within this model consists of using agency to seek opportunities, relationships, and environments that inspire growth and meaning, while accepting all aspects of oneself in the process (Ryff, 1989, Ryff & Keyes,
1995).
Ryff and colleagues (Ryff, 1989; Ryff & Keyes, 1995) propose that these six dimensions are distinct and all are needed to fully capture PWB. However there is debate about the factor structure and extensive overlap among Ryff’s six dimensions (Abbott et al., 2006; Abbott et al., 2010; Burns & Machin, 2009; Cheng & Chan, 2005; Fernandes,
Vasconcelos-Raposo, & Teizeira, 2010; Mehrotra et al., 2013; Sirigatti et al., 2009;
Sirigatti et al., 2013; Van Dierendonck, Diaz, Rodriquez-Carvajal, Blano & Moreno-
Jimenex, 2008). Some studies have found support for a six-factor model (one factor for each of the six dimensions; Cheng & Chan, 2005; Fernandes et al., 2010; Sirigatti et al.,
2009; Sirigatti et al., 2013; van Dierendonck et al., 2008). Other authors suggest using a four-factor model due to significant inter-factor correlations among environmental mastery, self-acceptance, personal growth, and purpose in life (Abbott et al., 2006;
Abbott et al., 2010; Chen et al., 2013; Mehrotra et al., 2013). The lack of consistent findings about the factor structure and uniqueness of the six dimensions is a limitation of
Ryff’s (1989) theory.
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Another limitation of Ryff’s theory is that the relationship among her model and other variables depends on if a researcher uses the overall construct of PWB or just a few of the six specific dimensions (Anglim & Grant, 2014; Archontaki et al., 2013; Huppert et al., 2010; Ryff 1995; Ryff & Keyes, 1995; Springer, Pudrovska, & Hause, 2011). For instance, classic twin studies suggest that genetics predict overall PWB (Archontaki,
Lewis and Bates, 2013; Franz et al., 2012; Gigantesco et al., 2011; Kendler, Myers,
Maes, & Keyes, 2011; Keyes, Myers, & Kendler, 2010), but predict self-acceptance especially, suggesting this dimension of well-being has a substantial genetic component
(Archontaki, et al., 2013). Thus, it is important to consider both the total factor and specific dimensions of PWB when considering how variables relate to PWB. The next section reviews research on Ryff’s PWB, wellness, and mental health symptoms.
Research on Ryff’s PWB and Wellness
Research studies suggest that Ryff’s PWB is related to several physical health benefits (Kim, Sun, Park, and Peterson, 2013; Morsch, Shenk, & Bos, 2015; Palmeira et al., 2010; Stephens, Druley, & Zautra, 2002) and improved vocational outcomes
(Strauser, Lustig, and Çiftçi, 2008; Wright & Cropanzo, 2000; Wright & Bonett, 2007).
Recently the field has explored the mental health symptoms associated with Ryff’s well- being model (Bhullar, Hine & Phillips, 2014; Guppy & Weatherstone, 1997; Hamilton,
Nelson, Stevens, & Kitzman, 2007; Hutt, 2013; Jahnke, 1996; Uzenoff et al., 2010).
The general factor and specific dimensions of Ryff’s model appear to have a role in depression outcomes (Bhullar, Hine, & Phillips, 2014; Fava, 1999; Ryff & Keyes,
1995; Wood & Joseph, 2010). By conducting latent profile analysis (LPA), Bhullar,
Hine, and Phillips (2014) identified profiles of PWB in 207 White Australian university
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students (74.9% women). The authors performed LPA on the general factors and each of the dimensions of Ryff’s model. Results suggest there were five distinct profiles of PWB among the sample, each with incremental increases in the general PWB factor and varying levels of each dimension. Additionally, profile membership significantly predicted levels of depression, such that high levels or low levels of all six dimensions of well-being resulted in lower or higher levels of depression, respectively. The sub-factor of autonomy played an important role in buffering against depression for this sample, whereby participants with profiles ranging from moderate to very high global PWB had lower levels of depression when they also had above-average autonomy. The ability of high or low global PWB to predict depression outcomes is consistent with the literature
(Fava, 1999; Ryff & Keyes, 1995) and with other profile analysis studies on PWB and depression (Wood & Joseph, 2010). Overall, PWB appears to play a role in the extent to which people experience mental health symptoms, such as depression.
The above studies set a precedent for linking Ryff’s PWB dimensions to mental health symptoms. However, more research is needed on Ryff’s (1989) PWB in diverse groups. The next section begins with an overview of the available research on Ryff’s model of PWB in diverse groups and ends by discussing the applications of this model to
Black women specifically.
Ryff’s PWB, Diverse Groups, and Black Women’s Wellness
There are mixed beliefs about the empirical and theoretical appropriateness of
Ryff’s (1989) PWB as a model of Black women’s wellness. It is important to test how
PWB does or does not represent wellness in this population rather than assuming it is or is not appropriate. Indeed, there have been calls to explore the utility of PWB in diverse
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groups (Christopher, 1999; Constantine & Sue, 2006; Daraei, 2013; Frazier et al., 2006;
Mehrotra, Tripathi, & Banu, 2013). Ryff’s PWB can potentially be applied to diverse groups while taking into consideration the unique cultural values of that group. For instance, in the Indian culture of Daraei’s (2013) sample, obtaining higher education is critically important, and, thus, educational attainment is likely related to students’ meaning in life and personal growth. In this way, Ryff’s model has potential to capture wellness for diverse groups.
Research supports the potential applications of PWB to diverse populations.
Ryff’s model has been used with Jordanian women (Abdelrahman, Abushaikha & al-
Motlaq, 2014), parents of adolescents (Keresteš, Brković, & Jagodić, 2012), Southeast
Asian adults (Daraei, 2013; Mehotra et al., 2013), older adults (Butkovic et al., 2012) and many more populations. Other studies have explored how demographic variables (e.g. social class, age, gender) relate to and predict PWB (Daraei, 2013; Franz et al., 2012;
Gigantesco et al., 2011; Huppert, 2009; Kendler et al., 2011; Keyes et al., 2002; Keyes et al., 2010). For instance, PWB is significantly related to both age (Ryff, 1995; Ryff &
Singer, 2008) and gender (Daraei, 2013; Huppert, 2009; Ryan & Deci, 2001; Ryff &
Keyes, 1995) such that older adults and women consistently have higher levels of PWB.
This suggests that PWB may be related to various identity variables.
The above review demonstrates a growing trend in the current literature to test
Ryff’s (1989) model with diverse groups. To date, the relationship among identity and
PWB has been demonstrated in White, young, middle-class people. People of Color are disproportionately underrepresented in all areas of the wellness literature and specifically in the PWB literature. In order to further demonstrate the utility and robustness of PWB,
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more research is needed on how the definition and conceptualization of PWB fits for racially diverse groups (Christopher, 1999; Constantine & Sue, 2006; Daraei, 2013;
Frazier et al., 2006; Mehrotra, Tripathi, & Banu, 2013). The current study addresses this need by exploring the relationships among PWB and identity in Black women, a group who has been continually underrepresented in research on PWB.
Research on the factor structure of Ryff’s model has also has been primarily with
White people. This gap remains despite calls in the literature for continued evaluation of the factor structure of Ryff’s (1989) model in diverse groups (Cheng & Chan, 2005;
Kishida et al., 2004; Lindfors, Berntsson, & Lundberg, 2006). To answer this call, researchers have tested the factor structure of Ryff’s model within international populations, including Italian (Sirigatti et al., 2009; Sirigatti et al., 2013), Spanish (van
Dierendonck et al., 2008), Japanese (Kishida et al., 2004), Chinese (Chang & Chen,
2005), Portuguese (Fernandes et al., 2010), and Swedish (Lindfors et al., 2006) populations, among others. Overwhelmingly, results from these studies found support for the factor structure of Ryff’s (1989) model in international samples. Specifically, the above studies found the best-fitting model had a factor of overall PWB and six second- order factors representing Ryff’s (1989) six dimensions. All of the authors call for continued validation of Ryff’s scales in racially diverse populations, especially given the possibility for considerable overlap among the six factors (van Dierendonck et al., 2008) and some cross-loaded items (Chang & Chen, 2005). To date, there has been little consideration of the factor structure of Ryff’s (1989) PWB for racially diverse groups within the United States. The current study addresses this gap in the literature by testing the factor structure of Ryff’s PWB for Black women.
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Despite empirical studies with diverse groups and calls in the literature for more research on Ryff’s model with diverse groups, there are significant concerns about how the theoretical assumptions of PWB apply to Black women. From its inception, Ryff’s model was based on White, Western values, as she drew upon theorists such as Maslow,
Allport, Jung, and Erickson, all of whom operated from Western ideology (Christopher,
1999; Mehrotra et al., 2013). Indeed, the very idea of PWB as separate from physical or spiritual wellness is a Western concept (e.g. separation of mind and body) compared to the interconnectedness of mind, body and spirit in many communities of Color
(Christopher, 1999). The tenets of Ryff’s PWB also reflect Western values by espousing a self-orientation (e.g., self-acceptance, autonomy) in comparison to the other-orientation espoused by many Eastern and African values (Daraei, 2013). Overall, Ryff’s model is inherently linked to individualism as a Western ideal (Christopher, 1999).
There has also been a debate on the relevance of specific dimensions of PWB for people of Color. Autonomy and environmental mastery are argued to be especially inapplicable for racially marginalized groups (Christopher, 1999; Mehrotra et al., 2013;
Sue & Constantine, 2006). The White and Western ideology underlying autonomy is that one’s actions are not, and should not be, determined by others, but are determined of one’s own volition (see Christopher, 1999). This stands in contrast to the collectivistic values and interdependent self-construal of many people of Color. Environmental mastery assumes world is able to/should be controlled and manipulated. As Christopher
(1999) discusses, racially diverse groups often see the world as part of a larger order with a Higher Purpose that is Divinely ordained, not individually controlled. Despite concerns
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about how the theory applies to racially diverse groups, there is very limited empirical research testing this idea.
In fact, only one study has empirically tested the fit of Ryff’s dimensions for people of Color in the United States. In two exploratory factor analysis (EFA) studies,
Mehrotra, Tripathi, and Banu (2013) tested the fit of Ryff’s dimensions of PWB in Indian adults in the United States. While not reflective of all racial and ethnic groups, this study does provide some implications for the fit of Ryff’s model in racially diverse samples. In the first EFA of 323 participants (age 20-35), three of Ryff’s dimensions were replicated
(positive relations with others, autonomy, and self-acceptance), three dimensions did not emerge (personal growth, purpose in life, and environmental mastery), and two new dimensions emerged (future orientation and self-confidence). However, only the positive relations with others dimension emerged with the same items as Ryff’s (1989) scale (39- item version). The second EFA had 614 participants, roughly 50% of whom were women. The only dimension similar to Ryff’s model that emerged was positive relations with others, and this dimension retained five of the original items from Ryff’s (1989) subscale. Another dimension emerged that resembled Ryff’s self-acceptance subscale but did not load the same items from her scale. Similar to the original study, personal growth, environmental mastery, and purpose in life were not replicated in the second Indian adult sample.
Overall, the results from Mehrotra, Triphathi, and Banu (2013) suggest that not all dimensions within Ryff’s model of PWB are fitting or appropriate for racially diverse groups. In particular, personal growth, environmental mastery, and purpose in life may be least fitting for people of Color. This is consistent with the theoretical concerns that
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autonomy and environmental mastery may be less appropriate for people of Color. In contrast, positive relations with others may have consistent measurement and definition in racially diverse groups.
Ryff agrees that the dimensions in her model are influenced by cultural factors
(Ryff & Keyes, 1995; Ryff & Singer, 1998). In Ryff and Singer (1998), the authors state that cultural values and racial identity may influence how dimensions of PWB are expressed or defined. For instance, the authors discuss how African Americans may understand positive relations with others to reflect harmony within a relationship or service to one’s community. In comparison, European Americans may view positive relationships with others as getting their intrinsic needs met from interactions with other people. Regarding purpose in life, this dimension for White people may be to self- actualize, whereas purpose in life for Black people may be to facilitate the wellness of others, develop wisdom, and establish justice for the larger community (Ryff & Singer,
1998). Similarly, Both Ryff (1995) and Ryff and Singer (1998) recognize that autonomy and environmental mastery are potentially problematic reflections of PWB for African
Americans and other communities of Color. However, they maintain that these dimensions are not unfit for racially diverse groups, rather the dimensions are just expressed differently.
Ryff’s logic that her dimensions of PWB are applicable to all populations but may be ‘expressed differently’ is highly flawed (see Christopher, 1999). It is assumed that
White, Eurocentric values are the ‘right’ and ‘true’ values and implies that other racial- cultural groups must adapt to these values. Indeed, implying racial-cultural groups enact
PWB ‘differently’ assumes that how White people enact PWB is normal. Ryff fails to
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consider that the behavioral expressions of people of Color could be due to different cultural values altogether, not just atypical expressions of White cultural values. In essence Ryff is trying to apply White dimensions of wellness to people of Color. Her approach fails to acknowledge important race- and culture-based differences among people and this is a significant limitation of Ryff’s model.
This begs the question, why test Ryff’s (1989) PWB as an alternative model of wellness for Black women? There are two key reasons. First, it is possible that Black women whose race is less central to their self-concept may identify with dimensions of
PWB more than dimensions of a cultural model of wellness. Neblett and Carter (2012) suggest that people of Color whose race is not central to their identity endorse different aspects of wellness compared to people of Color who experience race as central to who they are. The extent to which various aspects of Black women’s identity relates to their wellness has not yet been tested. By including two models of wellness that are different in their conceptualization and theoretical basis, this study aims to provide Black women with a range of dimensions of wellness to identify with.
Second, Ryff’s model is increasingly being used with communities of Color without consideration of the empirical or theoretical appropriateness (e.g. Abdelrahman,
Abushaikha & al-Motlaq, 2014; Christopher, 1999; Constantine & Sue, 2006; Daraei,
2013; Frazier et al., 2006; Mehrotra, Tripathi, & Banu, 2013). It appears that theoretical gaps in Ryff’s (1989) PWB have not be enough to convince psychologists they should use a cultural model of wellness. With empirical data, psychologists with power and privilege could be more apt to accept the (in)appropriateness of PWB for Black women.
The current study can contribute the empirical evidence valued in psychology and inform
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psychologists about the limitations and strengths of both alternative and cultural models of wellness. In addition to the two models of wellness in this study, the final variable of interest is gendered-racial identity. The next section discusses the research on identity and wellness, including the intersectional model of gendered-racial identity used in the current study.
The Role of Racial Identity in Wellness
Racial identity is an individual’s “internalization of racial socialization that pertains to their group” (Helms, 2007, p. 236), or the “significance and qualitative meaning that individuals attribute to their [group] membership…within their self- concept” (Sellers, Smith, Shelton, Rowley, and Chavous, 1998, p. 23). Racial identity is distinct from ethnic identity, as ethnic identity refers to membership in a self-identified kinship group or the cultural practices of a group where the group does not have to be the same as the ascribed racial group (Helms, 2007). Racial identity is also distinct from race.
Race refers to sociopolitical constructions of group membership ascribed to individuals on the basis of biological characteristics, such as skin color or physical features (Carter,
2007). This section reviews research linking racial identity and wellness and discusses gaps in the literature addressed by the current study.
Racial identity is conceptually linked to wellness (see Haslam, Jetten, Postmes and Haslam, 2009). Drawing upon Social Identity Theory (Tajfel & Turner, 1979; 1986), our group memberships (e.g. racial identity, gender identity) influence our mental state by forming a sense of self, connecting us to a sense of purpose, and providing us with a psychological and social community (Haslam et al., 2009; Iwamoto & Lui, 2010; Pyant
& Yanico, 1991). These outcomes are similar to Myers’ (1988, 1993) dimensions of
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interconnectedness, spiritual reality, and interpersonal relationships and to Ryff’s (1989) dimensions of purpose in life and positive relations with others. However, as reviewed by
Haslam and colleagues (2009), social identities such as racial identity do not simply influence wellness; rather, racial identity defines wellness by outlining “much of what we live for and… live by” (p. 18). Thus, because racial identity is essential to defining the meaning of life for people of Color (Constantine & Sue, 2006; Sue & Sue, 2008), racial identity is also central to defining wellness in people of Color.
In addition to theoretical support, there is empirical support linking racial identity to wellness in people of Color (Molix & Bettencourt, 2010; Constantine & Sue, 2006), biracial individuals (Abu-Rayya, 2006), Asian Americans (Iwamoto & Liu, 2010;
Nguyen, 2015), and African Americans (Seaton, Scottham, & Sellers, 2006; Seaton,
Neblett, Sellers, Upton, & Hammond, 2011). A few conclusions can be drawn from the existent literature on wellness and racial identity. First, racial identity operates as a predictor of wellness for people of Color but not for White people (Abu-Rayya, 2006;
Molix & Bettencuort, 2010). Second, various identity statuses, such as those in racial identity development models (e.g. Cross, 1971; Parham & Helms, 1981), differentially relate to wellness (Iwamoto & Liu, 2010; Molix & Bettencourt, 2010; Nguyen, 2015;
Pierre & Mahalik, 2005; Seaton et al., 2006). Specifically, lower wellness is associated with identity statuses that devalue people of Color and emphasize White values (e.g., preencounter, dissonance) and statuses that involve immersion into in-group culture and anger towards Whiteness (e.g., immersion-emersion). Higher wellness is associated with racial identity statuses that hold a valued sense of self as a person of Color with critical
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consciousness about White culture (e.g. internalization). Overall, research suggests racial identity influences wellness of racially diverse people.
While there is support and rationale for studying how racial identity relates to models of wellness, gaps in the literature remain. First, most of the literature linking racial identity to wellness used self-esteem measures to operationalize wellness (see
Cross, 1991; Phinney, 1990 for a review). Thus, more research is needed linking racial identity to wellness as defined by Optimal Theory and PWB. Additionally, there is limited research on within-group differences in the relationship between racial identity and wellness (Constantine & Cue, 2006; Molix & Bettencourt, 2010). For instance, most studies explore this relationship for multiple racial groups at one time (e.g., Molix &
Bettencuort, 2010) or compare people of Color to White people (e.g., Abu-Rayya, 2006).
The current study addresses the lack of within-groups research by exploring differences in wellness among Black women.
A third limitation is the lack of intersectionality and failure to recognize multiple identities that influence wellness. Most studies in literature focus predominantly on how race influence wellness (e.g. Seaton et al., 2006; Seaton, et al., 2011) without consideration for the influence of gender. Even studies that explore PWB in specific populations with multiple identities, such as African American men (Pierre & Mahalik,
2005) or African American women (Settles et al., 2010), ignore the intersectionality of identities and fail to account for the influence of gender on PWB. The current study addresses the intersectional research by studying how gendered-racial identity influences wellness in Black women.
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A final limitation within this literature is the lack of a complex, multifaceted measurement of identity. This gap exists despite calls for more psychometrically sound and multifaceted measurement of racial identity (Frazier et al., 2006; Helms, 2007). The vast majority of the research on racial identity and wellness utilized Phinney’s (1992)
Multigroup Ethnic Identity Measure (MEIM; e.g. Abu-Rayya, 2006; Iwamoto & Lui,
2010; Molix & Bettencourt, 2010; Seaton et al., 2006). A few studies utilized Parham and
Helms’ (1981) Racial Identity Attitudes Scales (BRIAS/WRIAS; e.g. Nguyen, 2015;
Pierre & Mahalik, 2005). In her review, Helms (2007) identifies conceptual and psychometric problems with the MEIM, including the confluence of racial and ethnic identity. The MEIM also measures identity across multiple racial/ethnic groups, rather than measuring group-specific constructs such as the BRIAS/WRIAS do. Finally, the
MEIM does not assess statuses or stages of identity development; rather, it assesses level of commitment to a single group. When attempting to understand within-group differences in wellness, it is beneficial to use identity statuses because this allow for more within-group variation than does measurement of group commitment as a unitary construct (Helms, 2007). The current study addresses the lack of psychometrically sound and multifaceted measurement of racial identity by using the Multidimensional Model of
Racial Identity (MMRI; Sellers, Smith, Shelton, Rowley, and Chavous, 1998). This model has a corresponding measure titled the Multidimensional Inventory of Black
Identity (MIBI; Sellers, Rowley, Chavous, Shelton, & Smith, 1997). The next section discusses this model in depth.
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Multidimensional Model of Racial Identity
This section begins by discussing the key tenets of racial identity as defined by the MMRI. Then, I discuss the theoretical assumptions of the model, followed by its’ strengths and limitations. I end by reviewing the literature on the MMRI, Optimal
Theory, and PWB.
Sellers and colleagues (1998) describe their model of racial identity as a synthesis of universal properties and specific meanings of Black racial identity. They propose four dimensions to Black racial identity: salience, centrality, regard, and ideology. Salience is the extent to which race is a relevant aspect of someone’s self-concept in a specific moment or event. Given the specificity of the salience dimension, it is not measured in the scales for the MMRI and is instead manipulated in experimental or quasi- experimental studies. Whereas salience reflects the meaning of one’s race in specific situations, centrality reflects the level to which someone regularly defines herself or himself with respect to race. Thus, centrality is relatively stable across various situations.
The third dimension in the MMRI is regard, which is the positive or negative evaluation a person places on his or her race. Sellers and colleagues (1998) distinguish between two types of regard: private regard is how positively or negatively individuals view African
Americans and themselves as an African American, whereas public regard is how positively or negatively individuals believe other people view African Americans. The final dimension of the MMRI is ideology, which is an individual’s attitudes toward their racial group and beliefs about the way members of their racial group should act. Sellers et al. (1998) identify four distinct ideologies that reflect the uniqueness of being African
American: nationalist, oppressed, assimilationist, and humanist.
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Sellers et al. (1998) posit that certain ideologies are not more or less positive/healthy than others, and researchers should not attempt to label the ideologies as such. Other racial identity theorists, most prominently Cross, are also moving away from attaching labels of adaptive/maladaptive or healthy/unhealthy to racial identity attitudes or ideologies (see Cross, 1991; Worrell, 2008). There is insufficient theoretical support to link ideologies with wellness, and thus the ideologies are not measured in the current study. Additionally, most authors testing Sellers’ MMRI and wellness do not use the ideology subscales (e.g., Rowley, Sellers, Chavous, & Smith, 1998; Settles et al., 2010;
Yap et al., 2011).
Sellers et al. (1998) also outline key assumptions of their MMRI. First, identities are assumed to be both stable aspects within a person’s self-concept and influenced by situational factors (e.g., specific events). Whereas other racial identity models tend to view racial identity as a stable trait, the MMRI conceptualizes racial identity as interacting with both the situation and the individual’s personal, subjective interpretation of their race (Sellers, 1993). The second assumption of the MMRI is that the most valid indicator of identity is the individual’s perception of his or her racial identity, rather than behavioral indicators of racial identity. Next, as described above, the MMRI does not make any predictions or value judgments about what constitutes a positive/healthy racial identity versus a negative/unhealthy racial identity (see Sellers, 1993, p. 331; Sellers et al., 2008). A fourth assumption of the MMRI is the emphasis on the current status of an individual’s racial identity, rather than the development of racial identity over time.
Lastly, the MMRI assumes that individuals have multiple identities, including but not limited to race, gender, and occupation, and that these identities are ‘hierarchically
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ordered’ by relative importance depending on the meaning someone gives each identity.
This assumption is an important distinction of the MMRI from other racial identity models that do not explicitly acknowledge intersectionality.
Overall, the MMRI offers several advantages over other models of racial identity, specifically the commonly-used MEIM. First, both theoretically and psychometrically the
MMRI, and its corresponding measure the MIBI, allow for intersectionality of identities, specifically race and gender (Sellers et al., 1997; 1998). As discussed earlier, intersectionality is essential when considering the gendered-racial identity of Black women (Cole, 2009). Additionally, the addition of significance to racial identity (via centrality) is a key advantage of the MMRI over other models (Sellers et al., 1998) and provides improved ability to measure the diversity of what it means to be African
American. Finally, the MMRI emphasizes within-group differences, not similarities across multiple ethnic groups as in the MEIM (Sellers et al., 1998). Thus, using the
MMRI to measure identity allows the current study to detect within-group differences in
Black women’s gendered-racial identity and wellness.
MMRI and Optimal Theory
To the best of the author’s knowledge, one study to date has used the MMRI along with Myers’ (1991) model of wellness: Neblett and Carter (2012). The participants of this study were African American college students (n = 210). The authors used latent class analysis to identify racial identity clusters and the level of wellness associated with each cluster. They used all aspects of Sellers et al (1997; 1998) model, including ideology. Unfortunately, the authors only used the intrinsic self-worth dimension of
Optimal Theory and did not include the other aspects of wellness/optimal beliefs.
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Despite this limitation, their methodology provides support for the methodology of the current study, which is using canonical correlation to find clusters among Black women’s identity and wellness (see Chapter 3). They found three clusters of racial identity among their participants: integrationist (low centrality, similarities between all humans); race-focused optimist (high centrality, high private and public regard); and low regard/nationality (high centrality, low public regard). Each of the three groups had distinct patterns of wellness. The race-focused optimist group had the highest amount of wellness (as defined by the intrinsic self-worth dimension of optimal beliefs) whereas the other two group has low wellness. The results of Neblett and Carter (2012) suggest that there are within-group differences among Black people’s racial identity and these differences related to variations in wellness. The current study builds upon the work of these authors by identifying clusters of Black women based on their gendered-racial identity and linking these clusters with optimal beliefs and PWB.
MMRI and PWB
To the best of the author’s knowledge, two studies to date have used the MMRI along with Ryff’s (1989) model of PWB: Seaton et al. (2011) and Sellers et al. (2006).
The participants of both studies were African American adolescents, and neither study conducted analyses on the specific dimensions of Ryff’s PWB. Seaton et al. (2011) assessed the longitudinal relationship of racial identity, racism, and Ryff’s PWB for 560
African American adolescents (ages 12 to 18) using latent curve modeling. The authors were primarily interested in the moderating role of racial identity on the relationship between racism and PWB. As such, they did not test for the direct relationship of racial identity on PWB; this relationship is the focus of the current study. Racial identity did not
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moderate the relationship between racism and PWB. They found public regard and centrality were not significantly correlated with PWB across time, whereas private regard was significantly, negatively related to PWB across time. The results of Seaton et al.
(2011) suggest public regard and centrality are minimally related to PWB, if at all. In contrast, private regard appears to have a consistent negative relationship with PWB over time for Black adolescents, where higher amounts of private regard relate to lower PWB.
The negative relationship among private regard and PWB is unusual, as most studies found a significant, positive relationship between private regard and well-being outcomes
(Sellers et al., 2006; Sellers & Shelton, 2003; Settles et al., 2010; Yap et al., 2011).
Sellers et al. (2006), the second study on the MMRI and PWB in Black adolescents, found a strong, positive relationship of private regard to PWB. They had 314
(61% female) African American youth (ages 11 to 17) in their study. They used multiple regression, controlling for gender, age, and experiences with racial discrimination.
Results suggested a direct link between private regard and the global construct of Ryff’s
PWB, with more positive private regard related to higher PWB. Public regard and centrality did not significantly predict Ryff’s PWB. These results are consistent with
Seaton et al. (2011) where private regard appears to be the strongest predictor of PWB compared to the nonsignificant relationships of public regard and centrality to PWB.
Additionally, these findings are consistent with research in which private regard is positively related to PWB (Sellers & Shelton, 2003; Settles et al., 2010; Yap et al., 2011).
Overall, much more research is needed on the relationship of identity to wellness.
This is especially the case given that there are so few studies utilizing the MMRI with
Optimal Theory and PWB. There is growing evidence for the influence of private regard
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on wellness, although more research is needed. More research is also needed on Black women’s gendered-racial identity and wellness, specifically. It is possible that the relationships among the MMRI, Optimal Theory, and PWB are different for Black women given their unique gendered-racial experiences. The next section discussed the research Black women’s wellness and gendered-racial identity.
Black Women’s Gendered-Racial Identity and Wellness
As discussed earlier in this chapter it is essential to consider the influence of both racial and gender identities on Black women wellness (Brown & Keith, 2003; Cole,
2009; Speight et al., 2012). Interestingly, there have been mixed results regarding the ability of gender and racial identities to predict Black women’s mental health (Cooper,
Guthrie, Brown, & Metzger, 2011; Littlefield, 2003; Pyant & Yanico, 1991) and wellness
(Miles, 1998; Sanchez & Crocker, 2005; Yang, 2015; Woody and Green, 2015). To the best of the authors’ knowledge, there has not been a study on Black women’s identity and wellness as defined by Optimal Theory. There have been three studies with Black women that used the MMRI and Ryff’s PWB. Prior to discussing these three studies, I provide a review of the literature on gendered-racial identity (defined differently than the MMRI) and wellness (defined differently that Ryff’s PWB). While the operationalization of wellness and identity is different than the current study, the findings provide some general ideas about how identity relates to wellness for Black women.
Regarding mental health symptoms, Pyant and Yanico (1991) explored how racial identity and gender identity influenced Black women’s depression and self-esteem. Their participants (n = 143) were adult Black female college students (n = 78) and community members (n = 65). They measured racial identity using the Black Racial Identity Attitude
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Scale (BRIAS; Parham & Helms, 1981) and measured gender identity by assessing attitudes about the rights and roles of women. The authors found that only racial identity predicted Black women’s depression and self-esteem. In fact, gender attitudes were not significantly correlated with any other variables in their study. In contrast, studies that only measured gender identity and did not account for racial identity found that gender identity was linked with fewer depression, stress, and anxiety symptoms for Black women (Cooper et al., 2011; Littlefield, 2003). In general, the literature on mental health symptoms for this population suggests that gender identity predicts mental health symptoms when racial identity is not accounted for; however when measuring both racial and gender identity, only racial identity is a significant predictor of Black women’s mental health symptoms.
Regarding wellness, there has been limited research on racial and gender identity as it relates to optimal beliefs or PWB; most studies use self-esteem to measure wellness
(Miles, 1998; Sanchez & Crocker, 2005). Despite the limitation of not using Myers’ or
Ryff’s measures, there is support for a direct relationship of racial identity (as measured by the BRIAS) to self-esteem, but no relationship of gender identity to self-esteem for
Black women (Miles, 1998). However, when only measuring gender identity, and not accounting for racial identity, gender directly predicted Black women’s self-esteem
(Sanchez & Crocker, 2005). Saunders and Kashubeck-West (2006) did use Ryff’s PWB
(84-item version). However their population was only 13 percent African American and
57 percent European American. They did not measure racial identity and found that gender identity significantly and uniquely predicted Ryff’s PWB (both the overall construct and all of the dimensions except for self-acceptance and purpose in life).
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Overall, the literature suggests gender identity predicts Black women’s mental health symptoms and wellness only when race is not taken into consideration. Thus, the literature supports the predominance of racial identity, not gender identity, in predicting the mental health and wellness of Black women. These findings support the use of an intersectional measure of gendered-racial identity in lieu of a separate gender identity measure. Indeed, Black women endorse that an intersected, Black-woman identity is more central to their self-concept than a separate Black or woman identity (Settles, 2006;
Thomas, Hacker & Hoxha, 2011). The operationalization of an intersectional measure of identity is discussed in Chapter 3.
To conclude this section on gendered-racial identity as it relates to mental health symptoms and wellness for Black women, three studies are reviewed in depth. First, only two studies to date have examined the MMRI as a predictor of wellness in Black women
(Settles et al., 2010; Yap, Settles, & Pratt-Hyatt, 2011). However, these two studies operationalized wellness differently than Optimal Theory or Ryff’s PWB. Despite not using the variables in the current study, the results support the MMRI’s prediction of wellness for Black women.
Yap et al. (2011) tested the relationships of the MMRI to life satisfaction for 161
Black men and women, 56.5% of whom were female. The authors found that gender
(measured as a demographic variable) moderated the relationships of private regard, public regard, and centrality to life satisfaction for Black women but not Black men.
These results suggest Black women have unique relationships between the MMRI constructs and life satisfaction. Given these unique relationships for Black women, further investigation of the MMRI, Ryff’s PWB and Optimal Theory is needed.
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Settles et al. (2010) also used the MMRI in Black women (n = 379, ages 18 to
64), although they operationalized wellness as depression. The authors used multiple regression, and after controlling for age, found direct relationships of private regard and public regard to depression, such that women with higher public and private regard had lower depression. Although centrality was not a significant direct predictor of depression, it did play a moderating role such that the relationship of private regard to depression was strongest for women high in centrality. Public regard, however, predicted depression regardless of the level of centrality. The result of Settles et al. (2010) suggested Black women’s beliefs about themselves (private regard) significantly impact their mental health symptoms when race is central to their identity, and their beliefs about what other people think of their group (public regard) impact their mental health symptoms regardless of how central race is to their identity. Again, more research is needed on the relationships among MMRI constructs and Black women’s mental health symptoms and wellness.
Only one study to date has used Ryff’s (1989) PWB with Black women participants. Yang (2015) used SEM to test a model with Ryff’s PWB as a mediator of the relationship between racism and psychological distress from racist events. The participants were 659 Black women. Although the author did not account for racial identity or gender identity, Yang (2015) provides insight into how Ryff’s PWB model might fit for Black women. After controlling for age, education, and marital status, racism uniquely predicted lower environmental mastery and greater personal growth, but did not predict other dimensions of Ryff’s PWB. Although Yang (2015) measured racism
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(not identity) as the predictor of Ryff’s PWB, this study sets a precedent for connecting race to Ryff’s PWB in Black women.
As a whole more research is needed on the relationships of the MMRI to wellness
(both Optimal Theory and PWB) for Black women. Not only is there a lack of research with this population, but there is also limited use of the MMRI, Optimal Theory, and
PWB constructs. This exists despite the fact that all of these constructs are more robust and multidimensional compared to other measures predominately used in the literature.
Additionally, more research is needed to test the unique relationships that may exist for
Black women among aspects of gendered-racial identity and two models of wellness. The above review shows that the connection among identity and wellness is complex; the centrality and regard of Black women’s gendered-racial identity is likely to have unique relationship to various dimensions of wellness. Despite the richness of this possibility, it remains unknown and unexplored. Overall, this study adds to the literature by testing the appropriateness of both a cultural model of wellness and an alternative model of wellness for Black women. This study aims to answer an important question about how Black women define wellness, recognizing that both optimal beliefs and PWB have potential contributions.
Summary and Hypotheses
The current study filled an important gap in the literature on Black women’s wellness and gendered-racial identity. Myers’ Optimal Theory (Myers 1988, 1991, 1993) represents a systematically-derived, intersectional, universal model of wellness. She postulates that optimal beliefs (e.g. spiritual sense of reality, interpersonal relationships, self-knowledge, intrinsic self-worth, holistic worldview etc…) result in wellness,
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liberation, and power to define one’s reality. Ryff’s construct of PWB (Ryff, 1989; Ryff
& Keyes, 1995) has also been established as a robust, theory-based conceptualization of wellness (Lent, 2004; Ryff, 1989; Ryff & Keyes, 1995; Ryff & Singer, 1998). Her construct encompasses multiple dimensions of wellness, including autonomy, personal growth, mastery over the environment, positive relations with others, purpose in life, and self-acceptance (Ryff & Keyes, 1995). Literature has demonstrated that wellness is strongly related to sociodemographic variables (Daraei, 2013; Huppert, 2009; Ryan &
Deci, 2001; Ryff & Keyes, 1995; Keyes et al., 2002) and gendered-racial identity (Miles,
1998; Sanchez & Crocker, 2005; Saunders & Kashubeck-West, 2006; Settles et al., 2010;
Yap et al., 2011).
Despite the knowledge that identity relates to wellness, this relationship has not been explored in Black women. Thus, the current study added to the literature in several important ways. First, the factor structure of Ryff’s model was untested in Black women until the current study. The appropriateness of Ryff’s PWB for people of Color has been called into question (see Christopher, 1991), especially the environmental mastery and autonomy dimensions (Daraei, 2013; Mehrotra et al., 2013). Yet, researchers continue to use Ryff’s model in diverse groups without consideration for how the theoretical assumptions and factor structure may not be applicable. Thus, more research is needed to understand the theoretical and psychometric appropriateness of Ryff’s PWB for Black women.
Second, more research is needed on Black women’s wellness (Moradi, 2012;
Yoder et al., 2012), of which PWB is only one component (Prilleltensky & Fox, 2007;
Prilleltensky & Prilleltensky, 2003). Given the relational and collective cultural values
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often espoused by Black women (Ali & Levy, 2012; Crocker, Luhtanen, Blaine, &
Broadnax, 1994; Enns & Discher, 2012; Mokgatlhe & Schoeman, 1998), and the impact of societal oppression on Black women’s wellness (Perry, et al., 2013), we must consider models of wellness beyond Eurocentric models such as Ryff’s PWB. In order to create a broad picture of Black women’s wellness, the current study tests the appropriateness of two models of wellness for this population. The use of Optimal Theory, as a cultural model of wellness, has been explored in White people and Black men and women, but never Black women specifically. Thus, the potentially unique definition of wellness espoused by Black women remains unknown and untested.
Finally, more research is needed on the relationship of wellness to Black women’s gendered-racial identity. Overall, the current literature suggests mixed results of how race and gender relate to Black women’s mental health (Cooper, Guthrie, Brown, & Metzger,
2011; Littlefield, 2003; Pyant & Yanico, 1991) and wellness (Miles, 1998; Sanchez &
Crocker, 2005; Yang, 2015; Woody and Green, 2015). Indeed, the current study aimed to bring clarity to the existent research on identity and wellness, and to do so in an underresearched population. To do this, I identified clusters of Black women based on their centrality and regard, and link these clusters to aspects of wellness that are most important to them. The current study also added to the literature on identity and wellness by using an intersectional measure of race and gender (Sellers et al., 1997; 1998). The use of gendered-racial identity in the current study was an improvement over studies that measured racial and gender identity separately (Sanchez & Crocker, 2005; Saunders and
Kashubeck-West, 2006).
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Overall, research on this topic is needed not only to understand what it means to experience wellness as a Black woman, but also to foster Black women’s wellness, and simultaneously, their empowerment and liberation. Indeed, “neither wellness nor justice is distributed evenly” (Prilleltensky & Fox, 2007, p. 793). Counseling psychologists are perfectly situated to correct the unequal distribution of wellness and liberation given our strengths-based and social justice values (Packard, 2009). The current study helps counseling psychologists to better understand what wellness means to Black women, how wellness relates to gendered-racial identity, and ways to foster Black women’s wellness.
Ultimately, this research provides an avenue by which counseling psychologists can equalize the uneven distribution of wellness.
In order to provide data that assists in the re-distribution of wellness for Black women, the current study proposed the following research questions which were analyzed using a mixed-methods approach. First, I explored how Black women defined wellness through qualitative content analysis of their responses to open-ended questions. Second, I examined the factor structure of Ryff’s construct of PWB (Ryff 1989; Ryff & Keyes,
1995) in Black women. Given the limited data on the factor structure of Ryff’s PWB in people of Color in the United States this was exploratory analysis without a-priori hypotheses. Third, I conducted exploratory analysis of which dimensions of Ryff’s PWB were most related to Black women’s mental health symptoms. Fourth, I explored optimal beliefs (Myers’, 1988, 1993) related to Black women’s mental health symptoms above and beyond PWB. I hypothesized that these additional, cultural components of wellness will significantly and uniquely relate to Black women’s mental health symptoms. Finally,
I explored the pattern of relationships among gendered-racial identity and wellness
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(defined using both optimal beliefs and PWB). In doing so, I identified the sets of relationships among gendered-racial identity and various dimensions of wellness, exploring which variables define each multivariate set. I hypothesized that at least one set of relationships, or pattern, will emerge from the canonical correlation analysis. The next chapter discusses these hypotheses and methodologies in-depth.
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Chapter III
METHOD
This study used a mixed-methods approach to data analysis. This chapter discusses both the qualitative and quantitative methodologies used in the current study on
Black women’s wellness. The following sections discuss the participants, recruitment, survey design, measures, research questions, and data analyses for implementing this study.
Participants
As this study focuses on Black women, this was the population recruited to participate. There were no restrictions on participants’ sexual orientation, social class, or other demographic characteristics; however, participants had to be at least 18 years of age at the time of the study. Regarding the number of participants needed, power analysis using G*Power for hierarchical linear multiple regression with two total antecedents, a medium effect size, and significance at the p < .05 level suggested 55 participants were be necessary to obtain .80 power. The recommended sample size for canonical correlation analyses is 10 cases per variable (Tabachnick & Fidell, 2013), which in the
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current study was 10 variables, and thus a minimum of 100 participants. Regarding the sample size for exploratory factor analysis (EFA), a commonly used method to determine sample size for EFA is a ratio of 10 participants per item (Costello & Osborn, 2005).
Following this rule of thumb, the current study needed 390 participants to run an EFA on the 39-item version of Ryff’s Scales of Psychological Well-being. However, other scholars suggest a ratio of 5 participants per item (Gorsuch, 1983) or 3 to 6 participantsper item (Cattell, 1978), resulting in a recommended sample size of 117 to
234 for the current study. Scholars recognize that using a ratio of participants to items can quickly escalate the minimum number of participants, and recommend a minimum number of participants instead (e.g. 100-250 participants, Gorsuch, 1983; 300 participants, Field, 2013). However, adequate sample size for EFA is not just determined by the ratio of participants to items or minimum number of participants, but also by the nature of the data (Fabrigar et al., 1999), including item communalities, minimum item loadings, and number of items per factor (Costello & Osborn, 2005; Hogarty, Hines,
Kromrey, Ferron, & Mumford, 2005; Kahn, 2011). For instance, a sample size of 100 can result in excellent factor congruence if it is expected that factors share a lot of common variance and that items will have high factor loadings (Hogarty et al., 2005; Kahn, 2011), as was the case for the 39-item version of Ryff’s scales. Given all of the above considerations, a minimum sample size of 150 to 200 people was recommended for an
EFA of Ryff’s 39-item measure of PWB. Given that the sample size requirements for the
EFA are more stringent that the requirements for regression or CCA, the minimum number of participants required for the current study was 150.
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Recruitment Procedures
Participants were recruited from multiple sources in order to maximum within- group variability. The sample was recruited from University of Akron psychology courses and various university and community organizations, forums, websites, and listservs pertaining to Black women. The specific recruiting procedures are discussed next.
University of Akron psychology Courses
The primary researcher obtained permission to post a description of the survey and the survey itself to Sona Systems, a site utilized by psychology undergraduates to complete research surveys for course credit (see Appendix B for invitation to UA students to complete the survey on Sona Systems). Participants were able to browse an array of possible research studies, and if interested, can choose to participate in the current study. The first page they saw was the informed consent page (see Appendix A for the informed consent), which provided the study rationale, length of time to complete the study, IRB approval number, the voluntary aspect of survey completion, and contact information for the study. Participants were required to give their consent to participate by clicking on a link at the bottom of the page that will direct them to the survey items.
They were then asked to self-identify in terms of race and gender. If the participant met the inclusion criteria they were directed to begin the survey; if they did not meet the inclusion criteria they were redirected to a ‘thank you’ page that explained they did not meet criteria and could choose to participate in a different study in Sona Systems.
Participants were not be required to complete all items to receive the Sona Systems credit and can exit the survey at any time. At the end of the survey students were provided a
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debriefing statement on the purpose of the study, the nature of wellness and gendered- racial identity (see Appendix E for the debriefing statement). The debriefing statement thanked participants for their time and provided contact information for the primary researcher and dissertation committee chair. At the bottom of the debriefing page, participants were provided with a link to the study and asked to pass the link on to another Black female they thought might be interested in participating. The debriefing page notified participants that e-mailing the link to another possible participant was voluntary and not required to receive course credit.
Members of online communities
Participants were also recruited through websites geared towards Black women.
This method is consistent with methods used in previous studies with this population
(Mattis, 2000; Pierre & Mahalik, 2005; Settles et al., 2010). Based on previous studies using this method (Settles et al., 2010), the following websites will be used: www.reddit.com/r/blackladies/, www.Hairboutique.com, www.bwwla.org (Black
Women for Wellness), www.nappturality.com, and www.topix.com/ forum/afam.
Participants were invited to partake in the survey via a posting that provides a description and rationale of the study, length of time to complete, IRB approval number, the voluntary aspect of survey completion, contact information for the study, and link to the survey on Qualtrics (see Appendix C for the website invitation to community members to complete the survey). Participants could exit the survey at any time. After completing the survey, participants saw a debriefing form thanking them for their time and providing the contact information for the primary researcher and dissertation committee chair. Also on the debriefing page, participants were provided with a link to the study, asked to pass the
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link on to another Black female they think might be interested in participating, and notified that e-mailing the link is voluntary. After completing the survey and viewing the debriefing page, participants were offered the option of receiving a five-dollar e-giftcard.
If they wanted the gift card they clicked on a link that opened up a separate screen where they entered their name and e-mail address. Gift cards were sent electronically to participants’ e-mail address (see Appendix L for the gift card e-mail to participants).
Participants’ survey responses were not be connected in any way to their name or e-mail.
Participants could choose whether or not to receive a gift card and they could exit the survey at any time.
Members of university communities
Black women were recruited from 40 universities across the United States (see
Appendix F for the complete list). Both historically Black universities and colleges
(HBCUs) and non-HBCUS were utilized for recruitment. To identify the HBCUs that would be used, a list of HBCUs (n = 99) was obtained from the Integrated Postsecondary
Education Data System, part of the National Center for Education Statistics and a division of the U.S. Department of Education (http://nces.ed.gov/ ipeds/datacenter/InstitutionBy Name.aspx). This list was ranked-ordered by total number of Black women enrolled in the 2013-2014 academic year. The 20 HBCUs with the highest number of Black women enrolled were selected as recruitment sites. A list of non-HBCUs was obtained from the same database above. The total list contained 7,687 universities/colleges, of which 99 were HBCUs and were removed. The remaining 7,588 non-HBCUs were ranked-ordered according to the total number of Black women enrolled in the 2013-2014 academic year. The 20 non-HBCUs with the highest number of Black
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women enrolled were selected as recruitment sites. Overall, the 40 universities were located in various geographic regions of the United States. Two methods, outlined below, were used to contact each university.
First, the primary author contacted faculty members in the Black Studies and
Gender Studies programs at the above-defined universities. Faculty members were asked to recruit potential participants from their classrooms and/or departments. An e-mail was distributed to faculty members which they could then distribute to their classes and/or departments. The e-mail contained a description and rationale of the study, length of time to complete, IRB approval number, the voluntary aspect of survey completion, contact information for the study, and link to the survey on Qualtrics (see Appendix D for the invitation to university students to complete the survey). Participants could exit the survey at any time. After completing the survey participants saw the debriefing page described above (see members of online communities) and were offered the voluntary opportunity to e-mail the survey link to another participant. After completing the survey and viewing the debriefing page, participants were offered the option to receive a five- dollar e-giftcard. The same protocol was followed as described above.
Second, the primary author contacted coordinators of student organizations at the above-defined universities that target the population of interest. Student organizations included Black Student organizations, Women/Gender organizations, NAACP chapters, and Black sororities. Similar to contacting faculty members, coordinators of these student groups were asked to recruit potential participants from their organizations. An e-mail was distributed to coordinators and/or organizations, which they could then distribute to their listserv. The e-mail contained a description and rationale of the study, length of time
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to complete, IRB approval number, the voluntary aspect of survey completion, contact information for the study, and link to the survey on Qualtrics. Participants could exit the survey at any time. After completing the survey participants saw the debriefing page described above (see members of online communities) and were offered the voluntary opportunity to e-mail the survey link to another participant. After completing the survey and viewing the debriefing page, participants were offered the option to receive a five- dollar e-giftcard. The same protocol was followed as described above.
Measures
This online survey consisted of a demographics questionnaire and measures assessing the following constructs: demographics, qualitative responses about wellness, optimal worldview, psychological well-being, gendered-racial identity, and mental health symptoms. The next sections discuss each measure and its psychometric properties.
Demographics Questionnaire
After completion of the informed consent, participants were directed to complete a demographics questionnaire (see Appendix G for the demographics questionnaire). This questionnaire asked participants to self-identify in terms of race, gender, sexual orientation, age, and religion/spirituality. They were also asked to identify the geographic region of the United States they currently live in (i.e. Midwest, South, etc.). Participants also identified how they arrived at the study, with the option to select University of
Akron Sona Systems, website, friend, e-mail from university department, or e-mail from campus organization. Finally, participants were asked to indicate (yes or no) if they recently filled out this survey. They were notified that their answer to this question will not affect any time compensation for participating. The information regarding age, race,
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and gender was used to remove individuals who did not meet the study’s inclusion criteria (i.e., self-identification as Black female who is 18 or older). Participants who indicated they completed the study previously were also removed.
Open Ended Questions
Participants were asked two opened questions in order to gather qualitative information about their understanding and definition of wellness. Participants were asked: 1) How do you define wellness (e.g. what does it mean to you to be well?) and 2)
What does your life look like when you are doing well (e.g. behaviors, activities, attitudes, etc…)? There was an open text box for each question into which participants could free-write their responses. The responses were analyzed for themes, focusing on what Black women self-report as dimensions of wellness.
Belief Systems Analysis Scale
The Belief Systems Analysis Scale (BSAS) is the corresponding measure for
Optimal Theory. It was developed by Montgomery, Fine, and James-Myers (1990) and measures a person’s self-reported adherence to an optimal worldview. Participants were asked to rate the degree to which they agree to a series of statements using a 5-point
Likert-type scale (5 = completely agree, 4 = mostly agree, 3 = neither agree nor disagree, 2 = mostly disagree, 1 = completely disagree). Results were calculated for a total score reflecting overall adherence to optimal beliefs. Total scores can be categorized in the following manner, with high scores representing more optimal beliefs and low scores representing suboptimal beliefs: Highly Afrocentric 160-135; Moderately
Afrocentric 134-110; Mixed Mainstream 109-85; Moderately Non-Afrocentric 84-60;
Highly Non-Afrocentric 59-32. To the best of the authors’ knowledge, subscales for the
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BSAS are not calculated but possible subscales are identified by Montgomery et al.,
(1990). To date, only Neblett and Carter (2012) have done subscale analysis with BSAS using only the intrinsic self-worth subscale. Only the total score was used in the currently study.
There were a total of 31 items on the BSAS. The guiding principle when developing items for the BSAS “was that it would be more effective to ask respondents to indicate how they would behave in specific situations rather than indicate the extent to which they adhere to abstract beliefs and values” (Montogomery et al., 1990, p. 43).
Sample items of the dimensions of wellness/optimal beliefs include: self-knowledge (i.e.
“in order to know what’s really going on you the need to look at scientific data rather than the individual’s personal experience (reverse scored)”; diunital logic “pain is the opposite of love: in other words, the act of love cannot cause pain (reverse scored)”; spiritual reality (i.e. “if I could make a choice, I would prefer to lead a wealthy exciting life as opposed to one that is peaceful and productive in terms of helping people (reverse scored)”; valuing interpersonal relationships (i.e. “there are some people in my past whom I believe I should never forgive (reverse scored)”); holistic worldview (i.e.
“although I have a favorite kind of music I listen to, I can usually get into an enjoy most kinds of music”); extended self-identity (i.e. “it is easy for me to see how the entire human race is really part of my extended family”); and intrinsic self-worth (i.e. “if I just had more money my life would be more satisfying (reverse scored)”; see Appendix K for the full BSAS).
While there are few studies that exist, given the limited research on Optimal
Theory and thus, the BSAS, the extant literature supports the use of this scale to measure
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wellness. The original validation study by Montgomery et al. (1990) conducted a factor analysis on the BSAS using principle component analysis. Their participants were White undergraduate college students (n = 140), 69 percent of whom were female. They found a five-factor solution that accounted for 38.3 percent of the total variance (Montgomery et al., 1990). The five factors were valuing interpersonal relationships, de-emphasis on appearance (e.g. the extent to which one uses nonmaterial factors in decisions; self- knowledge, spiritual reality), integration of opposites (e.g. diunital logic), nonmaterial based satisfaction (e.g. the degree of wellness not based on material objects; intrinsic self-worth), and optimism (e.g. the extent of perceived possibilities in a variety of situations; holistic worldview). The authors conclude that these factors are a parsimonious representation of Myers’ (1988, 1993) optimal beliefs.
Brookins (1994) validated the BSAS with Black college students (n = 171) attending a predominantly White university. Participants mean score on the BSAS was
108.69 with a standard deviation of 10.34. Brookings (1994) compared this score to that of White participants from Montgomery et al. (1990) whose mean score on the BSAS was 104.71 with a standard deviation of 13.05. A t-test revealed significant differences between the two mean scores, suggesting the scores of the Black college students were higher, on average, than those in the original White college student sample. This suggests that the BSAS is appropriate for use with Black participants, if not more so in this population compared to White participants. Brookins (1994) used principal component analysis to validate the factor structure of the BSAS for Black populations. With a few exceptions, he replicated the factor structure of the original study by Montgomery et al.
(1990). Specifically, the interpersonal relationships, de-emphasis on appearance (e.g. self
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knowledge, spiritual reality), and integration of opposites (e.g. diunital logic) scales replicated. The nonmaterial-based satisfaction (e.g. intrinsic self worth) had only three of the original six items loaded onto the same factor. Also, the optimism (e.g. holistic worldview) subscale did not replicate in this population at all. Overall, Brookins (1994) concludes that the factor structure of the BSAS is consistent for Black participants and recommends this measure for use with this population.
There is sufficient evidence for the reliability of the BSAS. In the development study on White participants the Cronbach’s Alpha was .80 (Montgomery et al., 1990).
The same study had 41 participants complete the measure twice within a one-week period. This resulted in a test-retest reliability of .63. Myers et al. (1996) provide data on the BSAS from an unpublished masters thesis and doctoral dissertation all with Black participants. In both these studies the Cronbach’s Alpha was .81 for the total scale
(Jackson, 1994; Sevig, 1993, as cited in Myers et al., 1996). In two other studies with
Black participants the reliability coefficients were .71 for the total scale (Brookins, 1994;
Neblett et al. 2010). Brookins (1994) conducted reliability analyses on the five subscales within the BSAS and found that all lacked sufficient reliability ( = .29 to .54). This lends further support for the use of the total score on the BSAS rather than subscales.
Overall, studies above find good reliability coefficients for the total scale of BSAS, suggesting there is sufficient internal consistency and test-retest reliability within the
BSAS. Thus, while the BSAS measures multiple dimensions of wellness, these dimensions all fall within one Afrocentric, optimal paradigm (Montgomery et al., 1990).
In additional to reliability, the BSAS also has sufficient construct validity. For instance, Montgomery et al. (1990) found that, as expected, BSAS total scores negatively
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correlated with endorsement of rigid, authoritarian, segmented beliefs (r = -.51, p < .001) and with a global measure of distress (r = -.38, p < .001). These results suggest that the
BSAS measures a belief system that represents wellness and is related to flexibility, tolerance, and holistic beliefs. Ewing et al. (1996) and Brookings (1994) also provide evidence for the construct validity of the BSAS. Their samples of Black students completed the BSAS and the Racial Identity Attitudes Scale (RIAS), a measure of racial identity statuses. As expected, the total score on the BSAS was significantly and negatively related to the preencounter racial identity status in both studies. The preencounter status reflects idealization of White cultural values, values that are similar to suboptimal beliefs. In this way, the BSAS measures an optimal belief system that represents wellness. The BSAS also has sufficient discriminant validity. As described by
Montgomery et al. (1990), out of the possible 93 correlations among the BSAS, global distress, and rigid beliefs, only 10 were above .30. Moreover, all of the correlations between BSAS and distress or rigidity were negative. This suggests that, as expected, the
BSAS measures a construct that represents health and flexible beliefs. Overall, with good construct and discriminant validity, BSAS is likely an accurate representation of optimal beliefs and wellness as defined by Optimal Theory.
Scales of Psychological Well-being
Ryff developed the Scales of Psychological Well-being in 1989 to measure overall well-being along with each dimension of her model (autonomy, purpose in life, positive relations with others, environmental mastery, self-acceptance, and personal growth). Participants were asked to rate their degree of agreement to a series of statements using a 6-point Likert-type scale (1 = strongly disagree to 6 = strongly agree).
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Results can be calculated for the overall measure and for each of the six subscales. Scores can be interpreted at the low and high ends, with high scorers generally having more
PWB over low scorers (see Table 2 for characteristics of high and low scorers). Sample items of the six subscales include: autonomy (i.e. “my decisions are not usually influenced by what everyone else is doing”); environmental mastery (i.e. “in general, I feel I am in charge of the situation in which I live”); personal growth (i.e. “I have the sense that I have developed a lot as a person over time”); positive relations with others
(i.e. “most people see me as loving and affectionate”); purpose in life (i.e. “I have a sense of purpose and direction in life”); and self-acceptance (i.e. “I like most aspects of my personality”; see Appendix I for the 39-item version of SPWB used in this study). Since
Ryff’s model was published, there has been considerable debate about the interrelatedness of the six dimensions (see Burns & Machin, 2009). In particular, Ryff
(1989; original 120-item version) and Ryff and Keyes (1995; 18-item version) found high correlations among self-acceptance, environmental mastery, self-acceptance, and purpose in life. Both studies conclude that these constructs are unique because they load onto different factors (Ryff, 1989) and predict outcome measures differently for different age groups (Ryff & Keyes, 1995).
Multiple versions of Ryff’s Scales of Psychological Well-being (SPWB) exist, including 9-, 18-, 24-, 39-, 42-, and 84-total item versions (see Sirigatti et al., 2013 and van Dierendonck, 2004 for reviews). The original SPWB developed by Ryff was 20- items per each of the six subscales, totaling 120 items (Ryff, 1989). This original version had strong reliability ( = .86 to .93) and appropriate relationships with corresponding measures of well-being, although Ryff (1989) did not test the factor structure. Yoder et
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al. (2012) used the 9-item autonomy, personal growth, and self-acceptance subscales from the 54-item version. The version with 18 total items (3 items per each of the 6 subscales) is the most commonly used by researchers (see Fernandes et al., 2010; Sirigatti et al., 2013). However, authors find support for Ryff’s 6-factor structure using the 18- item version (Chen & Chan, 2005; Fernandes et al., 2010; Sirigatti et al., 2009; Sirigatti et al., 2013), but the internal reliability of subscales are consistently poor (e.g., Fernandes et al., 2010, = .35 to .50; Ryff and Keyes, 1995, = .33 to .56). Ryff (2014) cites support for the use of the 42-item version (7-items per subscales) and recommends this version for use in research. However, the 42-item version has adequate reliability
(Morozink, Friedman, Coe, & Ryff, 2010, = .69 to .85; Ryff et al., 2007, = .70 to
.84), but authors have been unable to replicate the 6-factor structure (opting for a four- factor structure with better fit; Abbott et al., 2006; Abbott et al., 2010) and ultimately caution against interpreting subscales of the 42-item version (Springer & Hauser, 2006).
Thus, the 18- and 42-item versions appear unsuitable for use in research, especially research with racially diverse groups for whom there is a lack of literature on the psychometric properties of the SPWB.
A promising alternative that addresses the weak factor structure and lack of reliability of the other SPWB versions is a 39-item version created by van Dierendonck
(2004). In a two-part study, van Dierendonck (2004) reviewed the reliability and factor structure of the 18-item (3-items per subscale), 54-item (9-items per subscale), and 84- item (14-items per subscale) versions. Cronbach’s alphas and CFA results for these three versions were inconsistent: 54- and 84-item scales had high reliability but a poor factor structure while the 18-item scales had poor reliability but a strong factor structure. As a
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result, van Dierendonck (2004) developed new, shorter scales with the intent of balancing response burden, reliability, and factor structure. Based on the results of his two studies, he selected items that had the highest item-total correlations (above .3) on their respective scale and low cross-loadings on other scales (<.40). The result was subscales with six items (self-acceptance, positive relations with others, environmental mastery, purpose in life), seven items (personal growth) and eight items (autonomy), for a total of 39 items.
This 39-item version has been used in the recent literature to measure Ryff’s PWB
(Church et al., 2012; Cuadra & Díaz, 2012; Vecina, Chacón, Marzana, & Marta, 2013;
Vecina & Fernando, 2013; Vos et al., 2012; Vos et al., 2013). Importantly, van
Dierendonck (2004) translated Ryff’s original items into Dutch for his study, and later into Spanish (van Dierendonck et al., 2008). To the best of the author’s knowledge, only
Church et al. (2012) has used the English version of the 39-item SPWB and he reported adequate reliability of subscales in the English version (above. 70). Overall, the 39-item scale is the only version of the SPWB with both adequate reliability and factor structure, and the only version that maintains these psychometric properties in racially diverse groups. The next paragraphs discuss the factor structure, reliability, and validity in depth.
Indeed, the 39-item scale addresses a major problem of the factor structure of the
SPWB, given that there has been significant debate about the factor structure of Ryff’s model (see Abbott et al., 2006 for a review; Abbott et al., 2010; Burns & Machin, 2009;
Cheng & Chan, 2005; Fernandes, Vasconcelos-Raposo, & Teizeira, 2010; Mehrotra et al., 2013; Sirigatti et al., 2009; Sirigatti et al., 2013; Van Dierendonck, Diaz, Rodriquez-
Carvajal, Blano & Moreno-Jimenex, 2008). In his study, van Dierendonck (2004) found
2 adequate fit indices for a six factor model of the 39-item version ( = 1210.44, AIC =
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1406.82, NNFI = .84, CFI = .85, SRMR = .07), and these fit indices were similar those for the18-item version, which had the strongest factor structure of the three SPWB versions he tested. Another CFA study by van Dierendonck et al. (2008) tested one, two, three, and six factor models. The best fit for the data was Ryff’s six factor model with one underlying second order factor of overall PWB (van Dierendonck et al., 2008, (2 =
1898.3, CFI = .82, TLI = .93, SRMR = .07). Additionally, the subscales of the 39-item measure were moderately correlated with each other (r = .38 to .97) and with the global factor of PWB (r = .61 to .95), suggesting the factors are related, but unique given that items loaded cleanly onto their respective factors (van Dierendonck, et al., 2008). Cuadra and Díaz (2012) also used the 39-item version and found support Ryff’s six factor model over any other models they tested. Importantly, van Dierendonck et al. (2008) and Cuadra and Díaz (2012) conducted their analyses with Spanish samples, and as such, the above results provide support for the 39-item version as the only version of the SPWB to uphold
Ryff’s six factor structure in a racially diverse sample. Indeed, after reviewing several forms of evidence from various versions of the SPWB, including the 39-item version used in the current study, Ryff and Singer (2006) overwhelmingly conclude the evidence supports the six factor structure of their model.
The 39-item version also addresses findings that other versions of the SPWB have low internal consistently coefficients for diverse samples, specifically international populations (see Fernandes et al., 2010; Sirigatti et al., 2009; van Dierendonck et al.,
2008). In van Dierendonck (2004) the Cronbach’s alpha coefficients for subscales in a
Dutch sample were as follows: .72 for personal growth, .78 for environmental mastery,
.80 for positive relations with others, .81 for self-acceptance, autonomy, and purpose in
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life. Similarly, van Dierendonck (2008) found adequate reliability of the 39-item measure, with Cronbach’s alphas ranging from .71 to .82 for the subscales in a Spanish sample. Cuadra and Díaz (2012) found an alpha of .75 for entire 39-item scale. Church et al. (2012) had 1,379 college students from eight different countries (U. S., Australia,
Mexico, Venezuela, Philippines, Malaysia, China, and Japan) take the 39-item SPWB in their native language, including the English version of the 39-item scale for U. S. participants. Out of 48 total subscale alpha coefficients (6 subscales for each of the 8 countries), 32 (66%) were above .70. Additionally, all of the subscale alphas for the
English version were above .70. Although the sample of U. S. college students who completed the 39-item English version was majority White, the cross-cultural reliability of the 39-item SPWB is apparent from the results of Church et al. (2012). To date, only
Yang (2015) used Ryff’s PWB with African Americans, but did not report alpha coefficients or which version of the SPWB was used. Although, in two samples of
African American male and female adolescents, composite scale alphas for the 24-item version were .85 (Seaton et al., 2006) and .83 (Seaton et al., 2011), suggesting Ryff’s items have the potential for reliability with Black women. Finally, Ryff (1989) found sufficient six-week test-retest reliability of the original, 120-item version, with coefficients ranging from .81 to .88 for subscales.
Regarding validity, the items on van Dierendonck’s (2004) shortened version correlated substantially with the 14-item subscales from which they were selected (r = .91 to .95), which suggest construct validity and that the scales of the 39-item version cover the essence of the longer SPWB scales. Using EFA, van Dierendonck (2004) found further support for the construct validity of the 39-item version because the well-being
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dimensions loaded onto factors with similar well-being measures. For instance, positive relations with others loaded onto the same factor as other relationship-oriented measures, and personal growth and purpose in life loaded on the same factor as measures of inner resources and calling to a higher purpose/power. Finally, in the sample of U. S. college students from Church et al. (2012), the 39-item SPWB demonstrated convergent validity, as significant correlations were found between SPWB subscales and related measures, such as environmental mastery and competence (r = .34), personal growth and self- actualization (r = .32), and positive relations and relatedness (r = .42).
Outcome Questionnaire
In order to measure mental health symptoms, the Outcome Questionnaire 45.2
(OQ-45.2) was utilized (Lambert et al. 1994; see Appendix J). This study explored how the two models of wellness predicted Black women’s mental health symptoms. The OQ-
45.2 was chosen because it is an acceptable measure of overall mental health for non- clinical research populations and it provides a holistic picture of a persons’ subjective experience and functioning. The OQ-45.2 conceptualizes subjective experience and functioning as occurring in three domains: symptom distress (e.g., depression, anxiety), interpersonal relations (e.g., getting along with others), and social roles (e.g., functioning in school, work). These three domains correspond to the three subscales in the measure.
Thus, the OQ-45.2 aligned with the holistic, broader understanding of wellness utilized in the current study.
The OQ-45.2 is a 45-item self-report instrument. Total time to complete is five minutes on average. Participants responded to items using a 5-point Likert-type scale ranging from 0 (never) to 4 (almost always). Sample items included “I tire quickly”, “I
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am concerned about family troubles”, and “I feel stress at work/school”. Total scores and subscale scores can be calculated; however, reviewers (Pfeiffer, 2005; Hanson & Merker,
2005) and researchers (Gayle Thalmayer, 2014; Lambert et al., 2006) suggest only total scores are interpretable and usable. As a result, the subscale items and scores are not discussed in-depth in this review and were not used in the current study (see Lambert et al., 2006). Total scores can range from 0 to 180, with higher scores representing more disturbed functioning and mental health. The OQ-45.2 was adapted from the OQ-45, but the manual suggests the items on the OQ-45.2 are "essentially the same as those found on the original [OQ-45], with a few cosmetic alterations" (Lambert et al., 2004, p. 43). Thus, while most of the research on psychometric properties has been on the OQ-45, the findings of this research can be considered to reflect the properties of the OQ-45.2 as well.
The factor structure of the outcome questionnaire has been inconsistent, especially the structure of the three subscales (Gayle Thalmayer, 2014; Hanson &
Merker, 2005; Lambert et al., 2006; Pfeiffer, 2005). However, recent EFA and CFA studies found support for a 4-factor bi-level model in American participants, such that participants are responding to items with respect to the global distress (total score) and specific qualities of the item (subscale scores; Bludworth, Tracey, Glidden-Tracey, 2010;
Gayle Thalmayer, 2014). The OQ.45 demonstrates consistent concurrent validity with other measures of mental health, including the SCL-90 and Beck Depression Inventory
(Lambert et al., 2004). In general, the discriminate validity of the subscales is lacking
(see Gayle Thalmayer, 2014).
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While limited, there is some research that supports the cross-cultural validity of the OQ-45 (Lambert et al., 2004; Lambert et al., 2006; Nebeker, Lamber, & Hueffner,
1995; Winston, 2004). For instance, Nebeker, Lambert, and Huefner (1995) found no differences on total scores on the OQ-45 between African Americans and European
Americans. Additionally, Winston (2004) utilized MANOVA and stepwise discriminant function analysis to test if African-, Latino/a-, Asian-, and European Americans (total N =
3,070) responded differently to items on the OQ-45. The author found the groups’ responses differed on 14 items, with Asian Americans scoring higher than the remaining three groups on the majority of the 14 items. Finally, Lambert et al. (2006) conduct paired comparisons between racially diverse and White college counseling center clients,
29 of whom were African American matched with 29 European Americans (31% male,
69% female). The authors found no differences on OQ-45 outcomes or total scores between any of the groups. Overall, the above studies suggest the OQ-45.2 can be used with racially diverse groups, such as the population of the current study.
In addition to cross-cultural validity of the OQ-45.2, there is sufficient evidence of the reliability of this measure in racially diverse groups. For instance, Kearney,
Draper, and Barón (2005) examined a sample of racially diverse college counseling center clients (N = 1,166; 11.6% African American, 16.0% Asian American, 17.1%
International, 25.8% European American, and 29.5% Latino/a) and found strong internal consistency for the total scale (Cronbach’s α = .92). The original authors report the total scale internal consistency is .93, and another study supports this (Gayle & Thalmayer,
2014, Cronbach’s α = .94). Finally, the 3-week test-retest coefficient of the OQ-45 is .84
(Lambert et al., 2004).
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Multidimensional Inventory of Black Identity
The Multidimensional Inventory of Black Identity (MIBI; Sellers et al., 1997) is based on the Multidimensional Model of Racial Identity proposed by Sellers and colleagues (1998). The MIBI (see Appendix H) assesses the meaning one places upon being Black (regard and ideology subscales) and the significance one attaches to race in defining oneself (centrality subscales). The current study focused on centrality and regard of identity for Black women. In order to maximize the capacity of the MIBI to be intersectional, the stems of items were changed from “Blacks/Black people” to “Black women” (R. M. Sellers, personal communication, July 27, 2015). Thus, it was intended that this measure capture, to the extent possible, an intersectional identity of race and gender.
The MIBI is a self-report questionnaire, using a 7-point Likert-type scale (1 = strongly disagree, 4 = neutral, 7 = strongly disagree). Because the MIBI is based on a multidimensional understanding of racial identity, a composite score for the entire MIBI is not appropriate and scores are calculated for subscales only (Sellers et al., 1997; see website for Sellers’ research lab at http://sitemaker.umich.edu/aaril /measures). Higher scores represent greater amount of the construct of the particular subscale. Participants rated their agreement with statements like those discussed below. The stems of the sample items included here have already been changed to reflect the statement participants will answer. Centrality (8 items) is the level to which participants regularly define themselves according to race, or according to race and gender as in the current study. Centrality is measured by statements such as “in general, being a Black woman is an important part of my self-image”. Regard is divided into two forms: public (6 items)
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and private (6 items). Public regard reflects how participants believe other people view
Black women (e.g., “overall, Black women are considered good by others”) whereas public regard reflects how participants themselves view being a Black woman (e.g., “I feel good about Black women”). The ideology subscales reflect attitudes towards ones’ racial group and how members on ones’ racial group should act. Sellers et al. (1998) identified four ideologies, all of which are measured in the MIBI: nationalist, oppressed, assimilationist, and humanist. The authors note that none of these ideologies are more or less positive/healthy than others. In fact, Sellers et al. (1998) discourage researchers from attempting to label the ideologies as adaptive or maladaptive. Given the lack of theoretical support for linking MMRI ideologies to well-being, and the lack of use of the ideology subscales in research (e.g., Rowley, Sellers, Chavous, & Smith, 1998; Settles et al., 2010; Yap et al., 2011), the ideology subscales are not used in the current study.
In their seminal article, Sellers at al. (1997) explored the psychometric properties of the MIBI with African American college students attending a prominently White university or a historically Black university. Exploratory factor analysis supported the factor structure of the MIBI as three separate constructs: centrality, ideology, and regard.
Thus, the MIBI does not capture an overarching construct of racial identity with three factors. In line with the evidence for the uniqueness of the three factors, Sellers et al.
(1997) conducted reliability analyses on each subscale separately. Cronbach’s alphas were similar across both college settings, so the alphas of the full sample were as follows: centrality α = .77 and private regard α = .60. Public regard was dropped from further analysis due to low internal consistency, possibly because the original scale only had four items, just two of which loaded significantly onto the public regard factor (Sellers et al.,
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1997). The items for the public regard scale have since been re-written (see Sellers et al.,
1997) and researchers continue to use the revised, 6-item public regard scale (Rowley et al., 2007; Seaton et al., 201; Sellers & Shelton, 2003; Settles et al., 2010; Yap et al.,
2011).
Cokley and Helm (2001) conducted further validation of the MIBI using confirmatory factor analysis (CFA) and item-level analysis. Similar to the original authors of the MIBI, Cokley and Helm (2001) validated the MIBI on African American college students who attended either a historically Black university or a predominantly
White university. Confirmatory factor analysis supported Sellers et al. (1998) finding of the centrality, regard, and ideology as separate constructs. However, Cokley and Helm
(2001) note that, while this was the best model out of those they tested, the fit indices for the final model are “marginal at best” (p. 91).
Across both types of universities, Cokley and Helm (2001) report consistent reliability of the centrality, private regard, and public regard subscales (α = .73, .76, and
.74, respectively). These coefficients are consistent with what is found in the literature.
For instance, Sellers and Shelton (2003) found Cronbach’s alphas ranging between .73 and .75 for the centrality and regard subscales and Casey-Cannon, Coleman, Knudtson, and Velazques (2011) found alphas ranging from .74 to .78 in a racially diverse sample (n
= 160), 21.7% of whom identified as African American. Regarding the use of the MIBI with Black women specifically, Yap et al. (2011) and Settles et al. (2010) found similar reliability alphas (centrality α= .82 & .74; private regard α= .73 & .78; public regard α
= .84 & .77, respectively).
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Sellers et al. (1997) found support for the predictive validity of the MIBI in that scores on the MIBI related as expected to measures of race-based activities, such as having a Black friend and being enrolled in Black studies courses. Walsh (2001) replicated Sellers’ predictive validity results, finding that in both an American and British sample of Black people, contact Black people significantly related to centrality and public regard. Cokley and Helm (2001) found correlations among subscales and scales were in the theorized directions, supporting the construct validity of the MIBI. Further supporting the construct validity of the MIBI, Simmons, Worrell, and Berry (2008) found the centrality subscale significantly related to Cross’ immersion-emersion (r = .33, p <
.001) and internalization afrocentricity (r = .55, p = <.001) racial identity development stages (e.g. convergent validity), but not to preencounter or internalization multiculturalist stages (e.g. divergent validity). Finally, correlations between the MIBI and the African Self-Consciousness scale were significant in the theorized direction, thus supported the concurrent validity of the MIBI.
Intersectionality in the Current Study
The current study accounted for intersectionality by utilizing Sellers et al.’s
(1998) Multidimensional Model of Racial Identity (MMRI), which allows researchers to measure racial identity attitudes while simultaneously accounting for the influence of other identities, such as gender. The MMRI recognizes that individuals have multiple identities, including but not limited to race, gender, and occupation. Sellers and colleagues (1997; 1998) posit that race and gender are ‘hierarchically ordered’ by the relative importance each identity has to someone’s overall identity. Thus, while the
MMRI, and its corresponding measure the Multidimensional Inventory of Black Identity
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(MIBI), do not measure intersectionality directly, they allow for the measurement of intersecting, multiple identities.
One way to allow for intersectionality within the MIBI is to change the stem of the items to reflect the reference group of interest. The current study changed the stem of
MIBI items from “Blacks/Black people” to “Black women” (R. M. Sellers, personal communication, July 27, 2015). Other studies have changed the stems of measures, such as the Schedule of Sexist Events, from “women” to “Black women” in order to measure
Black women’s experience more intersectionally (see Thomas, Witherspoon, & Speight,
2008). Although changing the stems of items does not make the MIBI an inherently intersectional measure of Black women’s gendered-racial identity, this is the closest option available. To the best of the author’s knowledge, a truly intersectional measure of
Black women’s gendered-racial identity does not currently exist.
A separate measure of gender identity was not used in the current study because the literature suggests existing measures of gender and/or gender identity are not appropriate for or generally predictive of outcomes for Black women (Collins, 2000;
Miles, 1998; Moradi 2005; Pyant & Yanico, 1991). For instance, feminist identity is often used as a gender identity measure (Miles, 1998; Saunders & Kashubeck-West,
2006; Yoder, Snell & Tobias, 2012). However, feminist identity is context-dependent, acting differently for different populations and relating to well-being in different ways for
Black and White women. For instance, one study found that feminist identity exacerbated distress from sexual harassment for Black women and minimized distress from sexual harassment for White women (Rederstorff, Buchanan, & Settles, 2007). Additionally, feminist identity stages were developed based on the experiences of White women and
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ignores the race and class oppression often experienced by Black women (Collins, 2000).
Overall, feminist identity may not be an appropriate measure of gender identity for Black women.
Research and scholars have suggested a womanist identity, rather than feminist identity, better captures the gendered-racialized experiences, oppression, and attitudes of women of Color (Boisner, 2003; Moradi, 2005; Walker, 1983). However, womanist identity measures have been found to be psychometrically inadequate (see Moradi, 2005, for a review). One study found that womanist identity measures failed to significantly differentiate womanist identity from feminist identity for African or European American women (Boisner, 2003). Furthermore, racial identity and womanist identity equally predicted Black women’s appraisal of racial and gender discrimination; womanism did not uniquely predict awareness of discrimination (King, 2003). Thus, womanist identity may not be a useful or unique measure of gender attitudes for Black women.
Rather than use feminist or womanist identity measures, some studies operationalized Black women’s gender identity with measures that test the extent to which participants endorse masculine, feminine, and/or androgynous sex roles (e.g.
Children’s Sex Role Inventory, Cooper et al., 2011; Bem Sex Role Inventory, Littlefield,
2003; Personal Attributes Questionnaire, Saunders & Kashubeck-West, 2006). These measures are not intended to capture participants’ attitudes and beliefs about their gender, which is the goal of the current study. Rather, these measures capture the extent to which participants behave in traditionally masculine, feminine, and/or neutral ways.
Additionally, measures of sex roles (i.e. femininity, masculinity, and androgyny) are based on White cultural values/definitions of sex roles, which are different from Black
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cultural values/definitions of sex roles (see Littlefield, 2003). As a result, sex role inventories are not a good measure of Black women’s gender identity. Other measures commonly used in the literature to assess Black women’s gendered-racial identity are the
Schedule of Sexist Events combined with the Schedule of Racist Events (Fischer & Holz,
2010; Moradi & Subich, 2003; Perry, Harp, & Oser, 2013; Perry, Pull, & Oser, 2012).
Again, these measures do not assess Black women’s beliefs and attitudes about their gender; rather, they assess the extent to which Black women experience racism and sexism in their daily lives. Therefore, the Schedule of Events, as the other measure commonly used in the identity literature, is not an adequate measure of gender identity.
The above review suggests feminist, womanist, and sex role endorsement measures may not appropriately or fully capture Black women’s gender identity. Thus, the current study used an intersectional perspective and an integrated measure of gendered-racial identity by using “Black women” stems in the MIBI (Sellers et al., 1998).
Research Questions and Hypotheses
Based upon the literature reviewed in Chapter II, the following research questions, hypotheses, and data analyses are proposed for this study:
1. How do Black women define wellness?
a. Hypothesis: Given the qualitative and exploratory nature of this research
question, no hypotheses are presented.
b. Analysis: Qualitative content analysis
2. What is the factor structure of Ryff’s PWB construct for Black women as measured
by the SPWB?
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a. Hypothesis: Given the exploratory nature of this research question and the
limited support for a 6-factor structure in diverse samples (Daraei, 2013;
Mehrotra et al., 2013), no hypotheses are presented.
b. Analysis: Exploratory Factor Analysis
3. Which dimensions of the PWB (SPWB) most relate to Black women’s mental health
symptoms (OQ-45.2)?
a. Given the exploratory nature of this research question, no hypotheses are
presented.
b. Analysis: Multiple Linear Regression
4. Do optimal beliefs (BSAS) relate to Black women’s mental health symptoms (OQ-
45.2) above and beyond psychological well-being (SPWB)?
a. Hypothesis: Optimal beliefs will significantly and uniquely relate to Black
women’s mental health symptoms above and beyond psychological well-
being.
b. Analysis: Hierarchical Regression
5. What are the patterns of relationships among gendered-racial identity and wellness
for Black women? Specifically, what are the patterns of relationships among Black
women’s centrality and regard of their gendered-racial identity (MIBI) and the
dimensions of optimal beliefs (BSAS) and psychological well-being (SPWB)?
a. Hypothesis: At least one canonical function will emerge.
b. Analysis: Canonical Correlation Analysis
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Proposed Analyses
Overall, this study will utilize a mixed-methods approach to data analysis.
Quantitative data cleaning followed the steps of Tabachnick and Fidell (2007). First, all participants who did not meet the inclusion criteria and who did not complete the survey were be removed from the data set. After calculating all of the appropriate scale and composite scores, the amount of missing data was explored. Missing data was analyzed at both the item- and case-levels. Following Parent (2013), mean imputation was utilized in cases with less than 20% of missing data. Cases with greater than 20% of missing data were removed and the percentage will be recorded. Finally, the data was screened for normality (e.g., skewness, kurtosis), univariate and multivariate outliers, and multicollinearity. After data cleaning, descriptive statistics were derived, including means and standard deviations for subscales and composite scales. Intercorrelation matrixes were produced for the composite scores and the subscales of all measures.
To address the first research question on how Black women defined wellness, I conducted qualitative content analysis of participants’ responses to two open-ended questions. Participants were asked 1) How do you define wellness (e.g., what does it mean to you to be well? and 2) How do you know when you’re doing well (e.g., behaviors, activities)? Responses to the open-ended questions were analyzed using common practices in the content analysis literature (Creswell, 1998; Mayring, 2000;
Miles & Huberman, 1994). However, there is no consensus for the best method of content analysis (Mayring, 2000). A qualitative software program was not utilized in the current study. The literature suggests that content analysis should include reviewing all the data prior to analysis, generating initial reactions/categories, reflecting and re-
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analyzing initial categories, and maintaining flexibility to allow for intuition, relativity, and uniqueness of the data (see Creswell, 1998). Based on these practices, content analysis in the current study was a cyclical loop of describing, classifying, and interpreting participants’ responses.
The second research question was the factor structure of the Ryff’s (1989) Scales of Psychological Well-being (SPWB) for Black women. To address this question an EFA was conducted using SPSS. While Ryff (1989) offered an apriori theory about the factor structure of the SPWB, an EFA is suitable for exploring the structure of a measure when used in racially diverse populations and similar EFA studies have been conducted on the
SPWB for this purpose (Mehrotra et al., 2013). Metrotra et al. (2013), the only other study to explore the factor structure of Ryff’s scales in diverse groups, used principal component analysis with varimax rotation. The current study used principal axis factoring as the method of extraction, as this is the standard for EFA and when using factor analysis to determine latent factors (Kahn, 2011). The factors were not correlated, thus orthogonal rotation was used (Kahn, 2011). After the extraction and rotation methods were applied, the number of possible interpretable factors was identified, which is often the most important decision in EFA (see Ledesma & Valero-Mora, 2007). The Kaiser parameters and visual scree test were reviewed to discern the possible number of interpretable factors, using Kaiser values greater than one and the number at which the visual screen test becomes flat (Fabrigar, Wegener, MacCallum & Strahan, 1999).
Parallel analysis (O’Connor, 2000) was also conducted to determine the possible number of interpretable factors by examining the number of factors before the raw data eigenvalues become smaller than the mean and percentile of the random data
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eigenvalues. To determine the number of possible interpretable factors it was important to consider theory (Fabrigar et al., 1999), such as Ryff’s proposed model of PWB, along with the combined information from the Kaiser parameters, scree test, and parallel analysis. Although it was also taken into consideration that parallel analysis is a superior method for determining the possible number of factors compared to Kaiser parameters or scree tests (Ledesma & Valeroa-Mora, 2007). After determining the number of interpretable factors, the reliabilities of the interpretable factors were examined to see if they are above .7, which is deemed an acceptable level of reliability (Nunnally &
Bernstein, 1994). Then, the factors were then explored for the number of items loaded onto that factor and the loadings of these items, with item loadings above .30 considered acceptable (Fabrigar et al., 1999). The amount of cross-loaded items was also be explored, as well as which items from Ryff’s scale did and did not load onto the theorized factor. Finally, if any factors emerged that did not resemble Ryff’s theorized factors, the items were explored to identify the latent construct of the new factor.
The third research question asked which dimensions of Ryff’s PWB relate to
Black women’s mental health symptoms. Multiple linear regression was used to address this question. Composite scores for the OQ-45.2 were entered as the dependent variable with subscale scores of Ryff’s PWB entered as the antecedents. The beta-weight for the subscale scores of Ryff’s PWB was significant at the p < .05 level, indicating that dimension of PWB significantly and uniquely predicted Black women’s mental health symptoms (see Chapter 4).
The fourth research question asked if optimal beliefs relate to Black women’s mental health symptoms above and beyond PWB. Hierarchical linear regression was
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conducted to answer this question. Composite scores for the OQ-45.2 were entered as the outcome variable and composite scores of psychological well-being (PWB) were entered as an antecedent into the first step. In the second step, the total score of optimal beliefs
(BSAD) were entered as the antecedents. The beta weights for optimal beliefs in Step 2 were significant at the p < .05 level, indicating wellness, as defined by Optimal Theory, significantly and uniquely predicted Black women’s mental health symptoms above and beyond PWB (see Chapter 4). The squared correlation coefficient (R2) and semi-partial correlation coefficients were also analyzed for how much variance of the dependent variable is accounted for the by the predictor.
The fifth, and final, research question asked about the relationship of gendered- racial identity to wellness. To address this question canonical correlation analysis was conducted (see Yoder et al., 2012 for an example). Canonical correlation analysis (CCA) identified how many functions exist between gendered-racial identity and the set of wellness dimensions. The first set of variables was gendered-racial identity; specifically the centrality, public regard, and private regard subscales of the MIBI. The second set of variables was wellness; specifically optimal beliefs (BSAS) and the dimensions of psychological well-being (SPWB; see Figure 1).
In CCA participants were grouped together (e.g. a multivariate function) based on similarities in their gendered-racial identity and wellness. For the purposes of an example, one group might be have high centrality, high private regard, and low public regard. This group (function) could be called ‘secure identity’, women endorse their gender and race as important to their self-concept and hold positive beliefs about their
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identities even if society does not. It is possible these women might endorse more optimal/Afrocentric wellness and relational dimensions of PWB given the centrality of
Canonical Correlation Analysis of Wellness and Identity
Figure 1 race and gender to their identity. Another function that could be identified by CCA might be participants with low centrality and low public regard. This group might be called
‘identity-neutral’, women whose identity is not central to their self-concept and believe society values them for their personhood and not their identities. These women might endorse more PWB/Eurocentric wellness given the neutral role of gender and race in their life. These examples simply serve to demonstrate the type of data CCA can provide.
It was hypothesized that at least one canonical function, or pattern, would emerge from the dataset. Participants were categorized into groups (functions) by maximizing the correlations between the two sets of variables: identity and wellness. CCA also identified the specific variables of identity and wellness that comprised each multivariate function
The following steps were used to identify the results of the CCA. First, the Wilks
Lambda coefficient was analyzed for significance, in order to determine if gendered-
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racial identity significantly relates to the set of wellness dimensions. Eigenvalues were used to determine how many functions are possible, whereas the dimension reduction analysis was used to determine which functions were interpretable, which was the number of functions that were significant at the p < .05 level. Finally, looking at the functions that are interpretable, and the particular variables that make up each function, the structural correlations (both positive and negative) were examined to identify the patterns of relationships among gendered-racial identity and dimensions of wellness. As demonstrated above in the example, each function was named in accordance with its highest loading on gendered-racial identity.
Conclusion
In brief, this dissertation sought to identify a definition of wellness for Black women using qualitative analysis and quantitative analysis of which dimensions of a cultural model and alternative model of wellness were most relevant for Black women.
By comparing these two models, this study aimed to provide information on dimensions of wellness related most strongly of Black women’s mental health symptoms. The current literature lacks a cogent understanding of how gendered-racial identity relates to Black women’s wellness. By exploring the relationships among gendered-racial identity and wellness in Black women, the current study hoped to foster this population’s wellness and liberation.
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Chapter IV
RESULTS
This chapter discusses the results of the current study on Black women’s wellness. The following sections discuss the data cleaning, demographics of participants, and results of the research questions and analyses of this study.
Data Cleaning
A total of 817 participants completed the study. Exploring the data, it was discovered that many of the responses appeared to be robot responses (e.g., entire survey responses often completed within 3 to 5 seconds by computer virus or macro). The following criteria were used to discern robot responses from genuine responses: survey completion time (e.g., under 5 minutes), random responding to quantitative questions
(e.g., lowest number for every scale, alternating between two numbers for all responses), and responses to open ended questions (e.g., advertising for a health/wellness product, exact response submitted several times in a row). Using these criteria, 498 responses
(61%) were determined to be robot responses and were removed from the data.
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After removing robot responses, the data cleaning steps of Tabachnick and Fidell (2007) were utilized. First, participants were screened for eligibility, including if they consented to participate, were 18 years of age or older, and identified as a Black/African American female. If the demographics information was left blank participants were removed from the data. There were 44 participants (5.3%) removed due to not meeting eligibility criteria. Lastly, 10 participants (1.2%) were removed due to significant amounts of missing data or completing the survey before. After the above steps, a total of 260 participants completed the survey
Next, the data were screened for missing data, skewness, outliers, and multicollinearity, each of which are discussed next. Scales and subscales were screened for missing data and most had below five percent missing data. Only the BSAS and OQ had significant missing data, 11% and 8.8%, respectively. Both the BSAS and OQ were screened for missing data at the item-level, which indicated the missing data were distributed throughout the scale and not on a specific item or items. All missing data were replaced using the participants’ scale or subscale mean score (Parent, 2013). Normality analysis was determined based on histograms and P-Plots, as skew statistics are not accurate for large data sets. Two subscales, MIBI Private Regard and SPWB Personal
Growth demonstrated negative and positive skew, respectively. Square root and logarithmic transformations were conducted until the distribution of each subscale better approximated the normal distribution. Using z-scores and histograms, the data were screened for univariate outliers. Two participants were removed due to having elevated z- scores and the appearance of being an outlier on the histogram. Then, mahalanobis distance scores were used to identify multivariate outliers with a chi-square value greater
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than 31.264, p = .001. Six participants were removed as multivariate outliers, bringing the final number of participants to 252 (30.8% of the original data). Multicollinearity was examined through tolerance (<.10), variance inflation factor (>5), collinearity diagnostics
(conditioning index > 30 and two or more variance proportions >.50), and bivariate correlations (>.90). None of the relationships among scales or subscales met any of the above criteria, indicating multicollinearity was unlikely to be an issue in this data.
Demographics of Participants
Demographic information is presented in Table 3 and discussed in detail below.
All 252 participants in this study identified as women, with 43.7% (n = 110) identifying as African-American, 51.2% (n = 129) as Black, 5.2% (n = 13) as Biracial, and .8% as other (n = 2, African and Hebrew Israelite). The majority of participants (60.7%) reported their ethnicity as American (n = 153). Of note, participants used various labels to describe their American ethnicity, including Black American, African American, American, and
African in America. The remainder of participants identified their ethnicity as Caribbean
(6.8%, n = 17), African (4.8%, n = 12), Haitian (4.8%, n = 12), Nigerian (4.8%, n = 12),
Other (4.4%, n = 11, Cameroonian, Congolese, Gambian, Moroccan, Sudanese, South
African etc...), and Latina (3.6%, n = 9). Twenty six participants (10.3%) left ethnicity blank. Participants ranged in age from 18 to 61, with a mean age of 29 (SD = 7.6).
Regarding sexual orientation, 10.3% of participants identified as Lesbian (n = 26), 4% as bisexual (n = 10), 83.3% as heterosexual (n = 210), and 1.2% as other (n = 3), including asexual and pansexual. The majority of participants (58.7%) did not have children, while
41.3% (n = 104) did have children. Participants with children had a range of one to eight children, with most having one or two kids (20% and14%, respectively).
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Table 3
Demographic Characteristics
Variable n (%)
Race Black 129 (51.2%) African-American 110 (43.7%) Biracial 13 (5.2%) Other 2 (.8%) Ethnicity American 153 (60.7%) Caribbean 17 (6.8%) African 12 (4.8%) Haitian 12 (4.8%) Nigerian 12 (4.8% Other 11 (4.4%) Age 18-25 93 (36.8%) 26-35 121 (48%) 36-45 30 (12%) 46-55 5 (1.9%) 56+ 3 (1.1%) Sexual Orientation Heterosexual 210 (83.3%) Lesbian 26 (10.3%) Bisexual 10 (4%) Other 3 (1.2%) Children Do not have children 148 (58.7%) Have children 104 (41.3%) Religion Christian-Protestant 146 (58%) Catholic 46 (18%) Mormon/LDS 21 (8%) Jehovah’s Witness 11 (4%) Non-religious (7%) Agnostic/Atheist (2%) Spiritual (1.6%) Other (1.3%) Muslim (.8%) Jewish (.8%) Education Some High School 6 (3%)
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High School 14 (16%) Some College 58 (23%) Associate’s Degree 56 (22.2%) Bachelor’s Degree 58 (23%) Master’s Degree 25 (10%) Doctoral Degree 4 (2%) Employment Status Full-time 148 (58%) Part-time 43 (17%) Full-time Student 23 (10%) Unemployed, Seeking Job 14 (5.6%) Unemployed, Not Seeking Job 7 (2.8%) Self-employed 6 (2.4%) Retired 5 (2%) Income Less than $15,000 31 (12.3%) $15,001 - $35,000 45 (18%) $35,001 - $50,000 65 (25.8%) $50,001 - $75,000 46 (18%) $75,001 - $100,000 40 (15.9%) $100,000+ 21 (8.3%) Note. Total number of participants is 252. Some percentages may not total 100% due to missing responses.
When asked about religion, 58% of participants identified as Christian-Protestant
(n = 146), 18% as Catholic (n = 46), 8% as Mormon/Church of Latter Day Saints (n =
21), and 4% as Jehovah’s Witness (n = 11). The remainder of participants identified as nothing/non-religious (7%), Agnostic/Atheist (2%), Spiritual (1.6%), Other (e.g., pagan, all inclusive, 1.3%), Muslim (.8%), and Jewish (.8%). Participants were relatively equally spread throughout the geographic regions of the United States, with slightly more participants living in the south (32%) as compared to 25% from the Midwest, 21% from the Northeast, and 20% from the West. On average, participants had some college experience, with most having either a few years of college (23%), an associate’s degree
(22.2%) or a bachelor’s degree (23%) as their highest level of education. Around 16% of
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participants listed high school as their highest level of education, followed by 10% with a masters degree, 3% with some high school, and 2% with a doctoral degree.
Most participants (58%) were employed full-time, with 17% reporting part-time employment and 10% reporting they were full-time students. The remainder of participants were unemployed and seeking a job (5.6%), unemployed and not seeking a job (3%), self-employed (2%), or retired (2%). The average income bracket was $35,001 to 50,000 (25.8% of participants). Participants’ incomes were equally spread above and below this average, with 34% of participants making above $50,000 and 30% making below $35,000. Of note, 12% of participants reported making less than $15,000 a year, which could be related to the large percentage of participants who are full-time students.
Most participants found the survey through a website (49%, n = 124), while the remainder were contacted through a friend (20%), university student organization (15%), university academic department (10%), or other/unknown (5%).
Basic Relationships
This section provides descriptive statistics for each of the scales and subscales used in this study, includes mean, standard deviation, Cronbach’s alpha, and basic correlations. This information is also provided in Tables 4 and 5. Consistent with what is recommended (Nunnally, 1978; Nunnally & Bernstein, 1994) the following standards were used to assess Cronbach’s alpha: α ≥ .70 is adequate, α =.60 to .69 is marginal, and
α ≤ .59 is low. All analyses were conducted using SPSS version 19.
BSAS
The mean on the BSAS was 96.2 with a standard deviation of 13.7. This suggests participants have a wide range of optimal beliefs (range = 65 – 135), from Moderately
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Non-Afrocenctric to Highly Afrocentric beliefs, Most participants are Mixed
Mainstream, representing an equal amount of optimal and suboptimal beliefs
(Montgomery et al., 1990). Greater endorsement of optimal beliefs was significantly
correlated with fewer mental health symptoms (r = -.57, p < .001). Additionally, scores
on the BSAS were significantly and positively correlated with all variables in the study
(rs = .37 to .58, p < .001) except for MIBI public regard (r = -.07, p = .262). Cronbach’s
alpha for the BSAS was .80.
Table 4
Descriptive Statistics of Scales and Subscales
Scale min-max min-max M SD α possible observed scores scores BSAS 32-160 65-135 96.2 13.7 .80 SPWB 39-234 77-226 149.2 27.04 .92 Confident Future 22-132 47-131 87.61 19.63 .93 Outlook Relationally- 17-102 28-97 61.64 12.73 .83 Oriented Decision Making OQ.45.2 0-180 2-128 71.63 26.46 .94 MIBI Private Regard 1-7 1-7 4.80 1.36 .86 Public Regard 1-7 1-6 3.78 .96 .67 Centrality 1-7 2-7 4.57 .92 .70 Note. BSAS = Belief Systems Analysis Scale; SPWB = Scales of Psychological Wellbeing – two-factor model; OQ.45.2 = Outcome Questionnaire 45.2; MIBI = Multidimensional Inventory of Black Identity.
SPWB 39-item version
Given that the factor structure of the SPWB was restructured for this sample (see
below in the section on EFA result), this paragraph pertains to the two new factors that
were developed out of the EFA: Confident Future Outlook and Relationally-Oriented
Decision Making. Participants demonstrated strong amounts of Confident Future Outlook
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(푀 = 87.61, SD = 19.63) and Relationally-Oriented Decision Making (M = 61.64, SD =
12.73). Consistent with high scorers on these subscales, this sample is likely to be self- determined, seek continued development, see self as growing and expanding, and experience supportive relationships in which they express concerns. Reliability for both subscales was strong; Cronbach’s alpha was .93 for Confident Future Outlook and .83 for
Relationally-Oriented Decision Making.
Table 5
Correlations among Scales and Subscales
Scale 1 2 3 4 5 6 7 8 1. SPWB total __ 2. SPWB Confident .89* __ Future Outlook 3. SPWB Relationally-Oriented .73* .36* __ Decision Making 4. BSAS .58* .37* .65* __ 5. OQ.45.2 -.59* -.38* -.66* -.56* __ 6. MIBI Centrality .55* .53* .35* .44* -.38* __ 7. MIBI Public Regard .08 .09 .03 -.07 .11 .08 __ 8. MIBI Private Regard .74* .72* .47* .55* -.45* .69* .04 __ Note. * = p < .01. BSAS = Belief Systems Analysis Scale; SPWB = Scales of Psychological Wellbeing – two-factor model; OQ.45.2 = Outcome Questionnaire 45.2; MIBI = Multidimensional Inventory of Black Identity.
The internal consistencies for SPWB subscales tend to be low (Fernandes et al.,
2010; Ryff and Keyes, 1995) but the coefficients obtained in the current study are consistent with, or higher than, those found by others using 39-item English version of the SPWB (Church et al., 2012). Confident Future Outlook and Relationally-Oriented
Decision Making are moderately correlated with each other (r = .36, p < .001) and moderately correlated with higher optimal beliefs (rs = .37 to .65, p < .001). As expected, higher overall PWB relates to fewer mental health symptoms (r = -.59, p < .001).
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OQ.45.2
Participants had a wide range of mental health symptoms (range = 2 to 128), with most having clinically significant symptoms (M = 71.63, SD = 26.46). Mental health symptoms were negatively correlated with all variables except for MIBI public regard (r
= .12, p = .066). The reliability of the OQ.45.2 was strong (α = .94).
MIBI
MIBI subscales scores can range from 1 to 7, with an average score of 3.5 (Sellers et al., 1997). The centrality subscale mean score was 4.57 (SD = .92). This suggests participants’ centrality is above average, or that they moderately define themselves according to their race and gender. Cronbach’s alpha for the centrality subscale was .70.
Higher levels of centrality were significantly correlated with fewer mental health symptoms (r = -.39, p < .001), greater PWB (rs = .35 to .55, p < .001), and more optimal beliefs (r = .44, p < .001). The public regard subscale measures how participants believe other people view Black women. The mean score was 3.78 (SD = .96), which falls in the average range out of possible scores on the MIBI. In other words, participants’ public regard is neither negative nor positive, but they believe the public holds both negative and positive views of Black women. Public regard was not significantly correlated with any variables in the study. Out of possible MIBI scores, participants had above average private regard (M = 4.80, SD = 1.36), suggesting they have positive views of themselves as Black women. Positive regard for themselves was related to fewer mental health symptoms health symptoms (r = -.45, p < .001), greater PWB (rs = .47 to .74, p < .001), and more optimal beliefs (r = .55, p < .001). The Cronbach’s alpha was .67 for public regard and .86 for private regard.
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Content Analysis
To address the first research question about Black women’s definition of wellness, responses to the two open-ended questions were analyzed using common practices in the content analysis literature (Creswell, 1998; Mayring, 2000; Miles &
Huberman, 1994). A qualitative software program was not utilized in the current study.
The first step was to read through all the responses and generate themes, which became a list of initial domains. Each response was read a second time, this time putting the response into a domain that best captured the essence of the participants’ words. A single response could be put into multiple domains. For instance, the response “wellness means people who have [a] healthy body and great pleasure” could have been put into both the physical health domain and pleasure/happiness domain. If a response did not fit into an existing domain, a new domain was created. Once all responses were placed into domains, the responses were read a third time to ensure the domain(s) that had been chosen captured the essence of the participants’ response. During this third review of responses, the names of domains were changed to more accurately reflect the content within the domain. Redundant domains were combined or turned into an overarching domain with subcategories. The last step was to create a list of the final domains and subcategories and calculate the total number of responses for each domain. A description of the domains for both open-ended question is next.
The first open-ended question participants answered was “how do you define wellness (e.g. what does it mean to you to be well)?” Four domains were created out of the responses to this question. Of note, fifty-eight participants left the answer to this question blank. The final domain list and number of responses are presented in Table 6.
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The largest domain (n = 72) was defining wellness as the integration of mental, physical, and social health. Participants described wellness as a holistic concept, encompassing physical health, supportive relationships, and emotional/mental stability.
To describe this holistic view of wellness, one participant wrote “wellness is how you measure yourself as a whole. Key points to consider are mental stability, physical fitness, and emotional maturity.” This domain had five subcategories, which reflect participants who defined wellness broadly, but emphasized a single domain as particularly important.
The subcategories include physical health (e.g. “body that is rarely sick,” n = 56), spiritual health (e.g. “having a healthy, spiritually engaged soul,” n = 18), mental health
(“absence of distress or worry,” n = 7), positive work environment and relationships (e.g.
“maintain professional relationships,” n = 6), or sexual health (“having regular sex,” n =
3). Thus, while most participants defined wellness as physical health or as an integration of multiple life domains, some Black women may emphasize a particular area of their life as more central to their wellness.
Another domain in the data was defining wellness as pleasure and happiness (n =
45), including “being happy in general,” “enjoying life,” and “finding joy and happiness daily.” This core also encompassed having a positive outlook on the future. As one participant states, “wellness means having general and overall positive feelings about one's self, current status, and future outlook.” This definition of wellness aligns with the concept of subjective well-being.
The third domain reflects wellness as a sense of balance and connection within yourself and your environment. This definition of wellness was endorsed by forty-five participants. As one participant described, wellness is “a point in your life where your
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mind and your body are connected as one instead of them separate and on different accords.” Women also described a sense of balance, stating wellness is “the point at which I am at an equilibrium,” “having balance in all aspects of my life,” and “being at peace and happy with most aspects of my life.” Part of this core included the self- awareness to know when one is experiencing balance and taking steps to “measure the quality of one’s life.” As one participant states, wellness occurs “once you know [how] you actually do want to invest time, energy, and resources into taking back control of your health and getting on the path of wellness.” This may correspond to self-knowledge within Optimal Theory and self-acceptance or personal growth within PWB.
Table 6
Content analysis for question one: How do you define wellness?
Domains f % Integration of mental, physical, social health 72 25.7 Physical health 56 20.0 Spiritual health 18 6.4 Mental health 7 2.5 Positive work environment 6 2.1 Sexual health 3 1.1 Pleasure and happiness 45 16.1 Balance and connection with self and environment 45 16.1 Ability and means to afford a healthy life 28 10.0 Total responses coded 280 100 Note. f = frequency, or the number of participant responses for each domain; % = percentage of the domain out of total responses.
The final domain (n = 28) described wellness as the ability and means to afford a healthy life. Participants in this group define wellness as having sufficient energy, power, and finances to enact wellness, or “the ability to do for ones self without any…hindrance.” Responses also suggest that wellness is the “ability to think about wellness,” which is a privilege reserved only for people who do not have to worry about
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other things. As on participant states, “wellness only applies to people who are successful and have a lot of money, because they can buy the means necessary for a healthy life.”
Participants might be alluding to how sexism, racism, and other oppression impacts their ability to think about or experience wellness. This category demonstrates the necessity of gendered-racial identity and cultural models of wellness in Black women’s experiences, as PWB neglects key factors that Black women report influence their wellness.
The second open-ended question was “what does your life look like when you are doing well (e.g. behaviors, activities, attitudes, etc…)?” Three domains were identified out of the responses to this question. Of note, sixty-nine participants left the answer to this question blank and thirteen participants stated they “didn’t know” what their life looked like when they were experiencing wellness. The final domain list and number of responses are presented in Table 7.
The largest domain (n =134) was people feeling “happy” when they are experiencing wellness. For instance, participants stated “I am happier, I smile more” and
“smiling most of the time.” Feeling happy also included a sense of confidence in oneself and the decisions you have made. One participant wrote “when I'm doing well, my life appears to be positive and moving towards a better and more successful direction.”
Happiness also indicated a sense of peace and calm, such as “I am at peace and feel less nervous,” “I am laid back,” and “life looks relaxed and free.” Feeling positive about the future and have an overall positive outlook was also part of feeling happy. As one participants states “I am very happy and outgoing and very eager to know what else is coming next.” Overall, Black women in this study viewed a sense of happiness as a key way to know if they are experiencing wellness. They also described this happiness as a
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multifaceted construct that includes viewing the future positivity, smiling often, feeling calm and peaceful, and having confidence in the state of your life. These relate to several domains with Optimal Theory and PWB, including self-knowledge, intrinsic self-worth, holistic worldview, personal growth, self-acceptance, and purpose in life.
Table 7
Content analysis for question two: What does your life look like when you’re doing well?
Domains f % Feeling “happy” 134 41.9 Engaged in a supportive environment 77 24.1 Engaging in supportive relationships 35 10.9 Giving back to others 14 4.4 Cultivating financial stability 15 4.7 Engaging in self-care 45 14.1 Total responses coded 320 100 Note. f = frequency, or the number of participant responses for each domain; % = percentage of the domain out of total responses.
The second domain was being engaged in a supportive environment (n = 77).
Overall this domain reflected “being energetic and productive” and “having a good energy to do everything...being very eager.” As one woman stated, “I am excited to get out of bed and get my day started. I wake up with a smile and excited to meet with people.” There were three subcategories within this domain. The first subcategory was engaging in supportive relationships (n = 35), such as “I foster positivity in my relationships and family” and “I do fun things with friends at least one or twice a week.”
The second subcategory is giving back to others (n = 14). Women stated they are helping others, serve as leaders in their community, and spreading love. The final subcategory was cultivating financial stability (n = 15). Participants discussed being responsible with
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their money while also spending money on activities in their environment. As one woman states:
I try to do the things on my bucket list in a reasonably time frame, I'm not
waiting for some special moment to do them … In a short period of time
we've had to replace a major appliance, AC/heating, water pump, tires and
still pay two car payments with regular household bill. I refused to stress,
we're making it work. It's life … and there is more I want to do and I'm
working to make them happen.
Overall, many Black women report they know they are experiencing wellness when they have energy to engage with their environment, including relationships, finances, and giving back to others. This domain reflects a sense of environmental mastery as suggested by PWB, while also valuing relations with others, diunital logic, holistic worldview, and intrinsic self-worth.
The final domain for this question was engaging in self-care (n = 45). Thus, participants knew they were experiencing wellness when they were taking care of themselves and getting their needs met. Self-care included eating healthy, exercising, and getting adequate sleep. Other aspects of self-care were the extent to which someone was engaging in hobbies, taking care of their physical appearance (e.g. hair, nails, skin) or having healthy, regular sex. Participants also discussed “engaging in a spiritual practice” and fostering their relationship with God as part of their self-care. While many Black women reported they experience wellness when they take care of themselves, the meaning of self-care may be unique to each individual. This domain suggests a balance
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of Optimal Theory and PWB, such that participants have autonomy to engage in their unique self-care rituals despite what others may think. Yet, participants’ self-care reflects an extended self-identity (e.g. spiritual practices as self-care) and an intrinsic self-worth
(e.g. self-care and physical appearance as a part of wellness, but worth is not solely based on this).
EFA of Ryff’s SPWB
The second research question explored the factor structure of the SPWB for Black women. EFA was conducted through SPSS and therefore fit indices are not provided. The current study used principal axis factoring (PAF) as the method of extraction. PAF is the standard for EFA and when attempting to determine latent factors (Kahn, 2011). Almost all correlations among the factors were lower than .32, which suggested using an orthogonal (e.g. independent) rotation (Kahn, 2011). Thus, varimax, a type of orthogonal rotation, was used. Results of KMO (.903) and Barlett’s test of sphericity (χ2 = 4887.27, p < .001) suggested that the items are suitable to undergo EFA. The next paragraphs describe the analyses and rationale that led to the final factor structure of Ryff’s scale in a population of Black women.
A visual scree plot indicated evidence for either three or six interpretable factors.
Parallel analysis (O’Connor, 2000) suggested it was possible to interpret up to six factors.
Based on Ryff’s theory that PWB is made up of six factors, the first analysis to be run was PAF extraction with varimax rotation, fixing the analysis to retain six factors. The six factor model explained 48.8% of the total variance. The results showed most items loading on the first three factors with factor loadings of .40 or above (e.g. 22 items on factor one, 9 items on factor two, 4 items on factor three). A few items loaded onto the
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next factors; 2 items onto factor four and 3 items onto factor five. The sixth factor had no items with a loading above .40. One item (item 35) was cross-loaded onto the third and fourth factor. Even though the scree plot and parallel analysis suggested it is possible to interpret up to six factors, results from the six-factor model did not support interpreting six factors for this data set. Thus, the factor structure of Ryff’s SPWB was not replicated in the current sample of Black women.
Further analyses were conducted to determine the amount of possible interpretable factors for this data. Again, PAF extraction and varimax rotation were used, this time without fixing the number of factors. Eigenvalues from this analysis suggested it was possible to interpret up to nine factors (Fabrigar, Wegener, MacCallum & Strahan,
1999). The nine-factor model accounted for 54% of the total variance. Upon examination of the nine factors produced by this analysis, most items loaded onto the first three factors
(factor loadings above .40). Specifically, there were 21 items on factor one, 9 items on factor two, and 4 items on factor three. Only a few items loaded onto the remaining factors (e.g. 2 items on factor four, 1 item on factor five, three items on factor six, 2 items on factor seven, 1 item on factor eight) and no items significantly loaded onto factor nine.
Additionally, six items were cross-loaded onto multiple factors and item 7 did not load significantly onto any factor. Thus, while eigenvalues suggested it was possible to interpret up to nine factors the results did not support interpreting nine factors for the current data. Also, Ryff theorized PWB is made of six factors, and thus a nine factor solution was not aligned with theory.
The next model tested was PAF rotation with varimax extraction, fixing the model to retain three factors. The total variance explained by these three factors is 41%.
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All items had significant factor loadings. Most items loaded onto the first two factors and three items loaded onto the third factor. The three items that loaded onto the third factor are #12, 13, and 20 (e.g. respectively: I tend to be influenced by people with strong opinions; given the opportunity there are many things about myself that I would change; it seems that most other people have more friends than I do). These items reflected a negative self-view; believing that you are easily influenced by others and that other people have more desirable qualities that you do. However, the three items that make up the third factor derived from different subscales: autonomy, self-acceptance, and positive relations with others subscales. In this model, there were no cross-loaded items.
To compare the three-factor model to a two-factor model, the next analysis was a model using PAF extraction and varimax rotation, fixed to retain two factors. The total variance explained by the two factors was 37%. All items loaded onto the two factors and all factor loadings are above .40. There were no cross-loaded items in the two-factor model. The items were evenly split between the two factors, with 22 items on the first factor and 17 on the second factor. Of note, the second factor contained all of the reverse coded items, along with one regularly coded item (item 30).
Comparing the two and three factor models, the two-factor model was more interpretable based on factor loadings and item content. The two-factor model had fewer cross-loaded items compared to the three-factor model. Additionally, comparing items across the two models, the factor loadings for items on the two-factor model were generally stronger than factor loadings for the model with three factors. Whereas the three-factor model explained an additional 4% of variance, this was not a substantial amount. Also, the three-factor model resulted in two factors with the majority of the
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items and a third factor that only had three items loaded onto it. The three items
(described above) that comprised the third factor did not have a coherent theme and this made the third factor indistinguishable from the other two factors. Thus, it was unlikely that having a third factor added significantly, or uniquely, to the interpretation of the factor structure of Ryff’s scale in a population of Black women. Not only does the two- factor model have stronger factor loadings, this model provided a more interpretable factor structure of PWB for Black women. See Table 8 for the factor loadings of the final two-factor model.
The following is a review of the items that comprise each factor. The first factor has 22 items and accounts for 23.7% of the total variance. The items come primarily from
Ryff’s purpose in life, personal growth, and self-acceptance subscales. Across the items are themes of hope about the future, openness to new, and challenging, experiences. For instance, the items that load most strongly on this factor (factor loadings above .70) discuss life as a continuous process of growth and the importance of new experiences to challenge oneself. This factor also comprises items that reflect self-confidence, including feeling “confident and positive about myself” (item 8) and “enjoyment about plans for the future and working to make them a reality” (item 22). Thus, factor one represents confidence in one’s ability to navigate challenges and the future and acceptance of the future as a continual process of growth and self-exploration. This factor aligns with the concepts of self-knowledge and intrinsic self-worth within Myer’s Optimal Theory
(Myers, 1993). Overall, to reflect the themes among items, factor one could be called
Confident Future Outlook.
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Table 8
Factor loadings for the final model of Ryff’s SPWB with Black women
Item Factor 1 Factor 2 22 .76 - 37 .75 - 23 .71 - 8 .71 - 32 .69 - 38 .68 - 6 .68 - 18 .67 - 19 .67 - 34 .66 - 11 .64 - 36 .61 - 31 .60 - 28 .59 - 15 .59 - 33 .58 - 5 .57 - 2 .56 - 1 .51 - 21 .51 - 14 .44 - 4 .43 - 27 - .63 25 - .62 35 - .62 9 - .60 10 - .60 7 - .56 39 - .55 24 - .53 16 - .53 3 - .51 12 - .49 26 - .49 30 - .49 29 - .46 13 - .43 20 - .43 17 - .41 Note. Factor loadings below .30 removed.
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The second factor in the final model has 17 items and accounts for 13.7% of the total variance. The items on this factor come primarily from Ryff’s positive relations with others and autonomy subscales. Themes among the items include achieving milestones in life, exercising agency, and meeting demands of daily living. High loading items (factor loading above .60) on this factor include “I can arrange my life in a way that is satisfying to me (wording changed to reflect reverse coding; item 27)” and “I feel satisfied about my achievements in life (wording changed to reflect reverse coding; item 25).”
Importantly, items on this factor indicate that any achievements a person makes occur in the context of relationships. Items reflect having people available to listen when you need to talk (item 9), expressing opinions to others even if it’s controversial (item 24), and experiencing warm and trusting relationships in which to share concerns (item 3). Thus, factor two represents accomplishing life goals, exercising agency, and making decisions, while also valuing the perspective and influence of close friends. This is consistent with
Myer’s (1993) concepts of extended self-identity and diunital logic. To reflect the themes among items, factor two could be called Relationally-Oriented Decision Making.
Overall, EFA results do not support the use of six-factor structure of PWB in a sample of Black women. In addition, the final two-factor model only accounts for 37% of the variance, which is low (Kahn, 2011). While limited, some information can be gleaned from this scale. The final factor structure suggests Black women may experience two domains of wellness: 1) confidence about themselves and their future and the challenges it will inevitably bring, and 2) agency to achieve life goals that are congruent with their relationships. Overall, data suggest that Black women’s endorsement of Ryff’s SPWB items are not consistent with Ryff’s hypothesized six factor structure, but rather can be
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organized into two factors that may reflect concepts of Optimal Theory. The two factor structure for Ryff’s SPWB was used for the remainder of the analyses, which are described next.
Regression Analyses
The third research question in this study asked which dimensions of Ryff’s PWB
(Ryff 1989; Ryff & Keyes, 1995) most strongly relate to Black women’s mental health symptoms, as measured by the OQ-45.2. Multiple linear regression was used to address this question, with composite scores for the OQ-45.2 entered as the dependent variable and the two factors of Ryff’s PWB entered as the antecedents. Table 9 summarizes the results of the regression analysis. The next paragraphs include the semi-partial correlation for each antecedent. The semi-partial correlation is the relationship between the antecedent (e.g., PWB) and dependent (e.g., mental health symptoms) variables when controlling for the other variables in the regression (Hayes, 2013).
Table 9
Summary of multiple linear regression for SPWB relating to mental health symptoms
Variable B SE β Confident Future Outlook -.216 .067 -.16* Relationally-Oriented Decision -1.25 .104 -.60* Making R2 .462 Note. *p < .001.
Both Ryff’s PWB dimensions significantly related to mental health symptoms (R2
= .46, p < .001). The two factors accounted for 46 percent of the variance in symptoms.
Confident Future Outlook significantly and uniquely related Black women’s mental health symptoms (β = -.160, p = .002), meaning greater coping with current and future
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challenges predicts lower depression, distress, and other mental health symptoms. Based on the squared semi-partial correlation, after controlling for Relationally-Oriented
Decision Making, Confident Future Outlook accounted for 2.2% of the variance in mental health symptoms (sr = -.149 , p = .002).
Relationally-Oriented Decision Making also significantly and uniquely related to
Black women’s mental health symptoms (β = -.605, p < .001). Thus, Black women experience lower levels of mental health issues when they have higher levels of satisfying and trusting relationships in which they can express concerns and receive support for life decisions. Based on the squared semi-partial correlation, after controlling for Confident
Future Outlook, Relationally-Oriented Decision Making accounted for 31.6% of the variance in mental health symptoms (sr = -.562, p = < .001 ).
The fourth research question asked if optimal beliefs related to Black women’s mental health symptoms above and beyond PWB. Hierarchical linear regression was used to address this question, with composite scores for the OQ-45.2 entered as the dependent variable. Total scores for PWB were entered as the antecedent into the first step of the regression, after which composite scores for optimal beliefs were entered as the antecedent into the second step of the regression. Table 10 summarizes the results of the regression analysis. Together in the regression, PWB and optimal beliefs accounted for
17.9% of the variance in Black women’s mental health symptoms (r2 = .424, p = < .000).
As hypothesized, optimal beliefs significantly related to Black women’s mental health symptoms above and beyond overall PWB (β = -.34, p < .001). Using the semi- partial correlation (sr), after controlling for PWB, optimal beliefs accounted for 7.7% of the variance in Black women’s mental health symptoms (sr = -.278, p = < .001). After
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controlling for optimal beliefs, PWB accounted for 10.1% of the variance in Black women’s mental health symptoms (sr = -.318, p = < .001). This suggests that both optimal beliefs and the two-factor version of PWB relate to mental health symptoms of
Black women. However, there is a large amount of unexplained variance in mental health symptoms. Chapter 5 discusses possible variables than may relate to the unaccounted for variance in Black women’s mental health symptoms.
Table 10
Summary of hierarchical linear regression for SPWB and Optimal Beliefs relating to mental health symptoms B SE β Model 1 SPWB -.577 .050 -.590** R2 .348 F 133.50** Model 2 SPWB -.383 .058 -.392** BSAS -.658 .115 -.340** R2 .424 F 91.82** Note. *p < .05, **p < .01. BSAS = Belief Systems Analysis Scale; SPWB = Scales of Psychological Wellbeing – total scores.
Canonical Correlation Analysis
The fifth, and final, research question in this study asked about the relationships between gendered-racial identity (e.g. MIBI centrality, public regard, and private) and wellness (e.g. optimal beliefs, two dimensions of PWB). Canonical correlation analysis
(CCA) was used to assess how the set of identity variables and set of wellness variables relate together. Results of the CCA suggest that gendered-racial identity significantly relates to wellness (λ = .36, F(9, 598.85) = 33.67, p < .001). Dimension reduction analysis suggested that one function was significant at a p < .05 level, suggesting identity and wellness were related to each other in one distinct way. This function explained 61
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percent of the variance (F = 33.67, Wilks’ λ = .369, p < .001). Canonical loadings, both positive and negative, were used to interpret the meaning of the canonical function (see
Table 11). The cutoff of .30 used to determine the strongest variables defining each group.
Function one can be called Central Gendered-Racial Identity. This group of women is characterized by high levels of centrality (.75) and private regard (.99). In other words, people in this group view their identity as a Black woman positively and believe it is a central part of their self-image. This function was also associated with a high amount of Confident Future Outlook (.91), Relationally-Oriented Decision Making (.60), and optimal beliefs (.70). Thus, women in this group reported a high amount of wellness overall and also experienced wellness in a variety of areas including beliefs, relationships, and social-cultural domains.
Table 11
Canonical loadings from canonical correlation analyses Variable Central Gendered-Racial Identity MIBI Centrality .75 Private Regard .99 Public Regard .06 SPWB Confident Future Outlook .91 Relationally-Oriented Decision Making .60 BSAS .70 Note. BSAS = Belief Systems Analysis Scale; SPWB = Scales of Psychological Wellbeing – two-factor model; MIBI = Multidimensional Inventory of Black Identity.
There was not a significant relationship to public regard for women in this function, suggesting that other people’s views of their identity as a Black woman is not
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related to their wellness. In sum, Black women who viewed their gendered-racial identity strongly and positively experienced a high amount of wellness that was not impacted by other people’s views of their identity. Specifically, their wellness embodied an optimal worldview, acceptance of their cultural identity and overall self, ongoing efforts to grow and develop, competence in navigating their environment, and trusting relationships to confide in. These results may suggest private regard is more related to Black women’s wellness that public regard, especially with a central racial-gendered identity.
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CHAPTER V
DISCUSSION
The primary purpose of this study was to explore Black women’s definition of wellness and the relationships among gendered-racial identity and wellness for Black women. The results indicated that cultural dimensions contributed uniquely to Black women’s definition of wellness and were strongly related to fewer mental health symptoms. Study results also clarified the aspects of wellness that are most important to
Black women depending on their gendered-racial identity. This chapter will describe these results and their implications, beginning with Black women’s definition of wellness. Next, the unique role of an optimal worldview for this population is discussed, followed by how wellness is related to gendered-racial identity. The limitations of the current study, future directions for research, and implications for counseling psychologists are also discussed.
Defining Black Women’s Wellness
This section reviews results from open-ended questions. In their responses to these questions Black women reported the main components to their wellness are holistic
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worldview, spirituality, self-awareness, a supportive environment, and liberation. First, wellness was defined as a holistic concept encompassing multiple domains. These domains included those listed above, as well as physical health, supportive relationships, engagement in their environment, and emotional/mental stability. Incorporating multiple dimensions into their definition of wellness reflected the interconnectedness among all things, people, and experiences. Many participants shared this sentiment, including on participant who spoke to wellness as “a point in your life where your mind and your body are connected as one instead of them separate and on different accords.” Women also described wellness as “the point at which I am at an equilibrium,” “having balance in all aspects of my life,” and “being at peace and happy with most aspects of my life.” Myers
(1991; 1993) defines this recognition of multiple aspects of life as a holistic worldview and Black women reflected this as a part of their definition of wellness.
Spirituality was another key domain that Black women emphasized in their definition of wellness. Similar to an optimal worldview (Myers, 1991; 1993) Black women knew they were doing well when they were spiritually engaged, seeking out a
Higher Power, and attuned to a spiritual (versus materialistic) sense of reality. Black women emphasized self-awareness as part of their definition of wellness, including knowing when you are experiencing balance in the above domains or when you need to re-evaluate and re-establish balance. Self-awareness is congruent with Myers’ (1991) self-knowledge. In both constructs, Black women defined, and reported experiencing, wellness when they had a deep understanding of self and relied on this inner knowledge to navigate their environment.
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Results suggested a supportive environment is also a necessary component of wellness for this population. This included being employed in a supportive environment, giving back to other people or the Black community, and having healthy friendships. In this way, Black women’s definition of wellness aligned with Myer’s (1991; 1993) concept of extended self-identity, in which wellness includes connection to other people rather than and individualistic self-identity. Another key aspect of the definition of wellness was liberation, such as access to resources and fewer societal constraints on health, balance, and wellness.
Overall, Black women defined wellness as balance among multiple life domains
(e.g. spirituality, emotional and physical health, supportive environment), trusting inner knowledge to know when one is, or is not, experiencing balance across domains, and liberation to be able to reflect on, and create, this balance in their own lives and in the lives of those in their extended interpersonal network. In this way, Black women viewed wellness as multifaceted construct that occurred at multiple levels: individual (self- awareness, physical health), relational (supportive relationships, connection to others), spiritual (healthy soul, sense of balance), and environmental (liberation, giving back to others).
The above definition of wellness offered by Black women is unique in two ways from dominant models of wellness in the literature. First, they defined wellness as a sense of balance and equilibrium among the multiple domains. Models of wellness typically used in the literature emphasize one domain as representative of wellness (e.g., subjective well-being or life satisfaction; Lent, 2004; Ryan & Deci, 2001). Black women did not viewed wellness as a unitary construct or as set of demands that compete for our attention
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and must be managed in order to be well. Rather, Black women viewed wellness as a complex phenomenon that occurs as individual, relational, environmental, and spiritual levels. These levels are not ranked in a hierarchy of importance and all are necessary to complete the ‘gestalt’ of wellness. This is congruent with diunital logic (Myers, 1993), where individual, spiritual, and relational needs are necessary to experience wellness rather than believing it has to be either/or. According to Black women, wellness is an ongoing process of seeking balance in multiple life domains and the self-awareness to know when you are out of balance.
Another key aspect that distinguished Black women’s definition of wellness was the emphasis on establishing balance without hindrances: in other words, experiencing liberation. Black women viewed access and opportunity as necessary for experiencing wellness. In the words of some participants wellness was “the ability to do for ones self without any…hindrance” or the “ability to think about wellness.” Liberation as a part of wellness included having sufficient internal energy, social power, and secure finances to enact wellness. As one participant stated, “wellness only applies to people who are successful and have a lot of money, because they can buy the means necessary for a healthy life.” Thus, wellness was viewed as a privilege reserved only for people who do not have to worry about other things. Wellness should not be limited to the people who have the means to buy a healthy life or who do not have to worry about other things due to privilege. Black women suggested their liberation from patriarchy, racism, and oppression is inherently connected to their wellness.
Other qualitative studies investigating the definition of wellness for racial minority religious faith leaders, women of Color in weight loss classes, and adolescents
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hold some similarities and differences to Black women’s definitions (Ahanonu & Jooste,
2016; McMahon et al., 2014; Webb, Bopp, & Fallon, 2013). Participants in these studies emphasized wellness as a holistic construct made up of spirituality, physical health, internal emotional health (e.g. peace/happiness) and interpersonal relationships. This is similar to the multifaceted nature of Black women’s definition of wellness. While some participants in these studies identified external influences on wellness (e.g., financial stressors, social institutions; Ahanonu & Jooste, 2016, Webb et al., 2013), Black women’s qualitative definition of wellness was unique in their emphasis on liberation and the ability to seek wellness without hindrances.
While authors have suggested that Black women must experience liberation and freedom from injustice in order to be well (Prilleltensky & Fox 2007; Prilleltensky &
Prilleltensky, 2003), the current study is one of only a few to hear directly from the voices of Black women that their wellness is intricately connected to their liberation.
According to Black women in this study, they are fostering their liberation by defining wellness from an optimal worldview and challenging suboptimal notions of reality
(Myers, 1993). For instance, by defining wellness as a holistic, spiritual, interconnection among self, others, and community, Black women are challenging the suboptimal worldview that defines wellness as material goods and individual achievements.
These findings contributed to the literature by offering Black women’s definition of wellness and supporting the use of Myers’ (1991) Optimal Theory as an appropriate model of wellness for Black women. These findings also suggested that psychologists also have an important role in increasing Black women’s wellness by working to end oppression, foster optimal beliefs, and create liberation. This is discussed further in the
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implications for practice. The next section discusses quantitative evidence that further established the role of an optimal worldview in predicting and defining Black women’s wellness.
The Importance of an Optimal Worldview for Black Women’s Wellness
Results of the exploratory factor analysis confirmed the importance of an optimal worldview (Myers, 1993) to Black women’s definition of wellness. The original six- factor structure of Ryff’s Scales of Psychological Well-Being (SPWB) was not replicated in this population. This is consistent with the few studies that have tested, and been unable to replicate, Ryff’s (1989) model of PWB in racially diverse groups in the United
States (Daraei, 2013; Mehrotra et al., 2013). Results suggested the most interpretable factor structure for the SPWB in this population was a two-factor model that explained
37% of the total variance. The two-factor model had stronger factor loadings and was more theoretically interpretable compared to the other models that were tested. All 39 of
Ryff’s original items loaded onto both factors; 22 items on factor one and 17 items on factor two.
The two factors that resulted from the data were Confident Future Outlook and
Relationally-Oriented Decision Making. Confident Future Outlook encompassed acceptance of the future as a continual process of growth and self-exploration and confidence in one’s ability to navigate future challenges. This factor had items from
Ryff’s (1989) purpose in life, personal growth, and self-acceptance dimensions.
Confident Future Outlook also aligned with an optimal worldview (Myers, 1993), specifically self-knowledge. Self-knowledge is accessing inner knowledge and coming to know oneself as a unique manifesting of Spirit. This represents the Confident Future
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Outlook factor, specifically the acceptance of continual self-exploration and use of self- confidence to handle future challenges.
The second factor, Relationally-Oriented Decision Making, encompassed accomplishing life goals, exercising agency, and making decisions, while also valuing the perspective and influence of close friends. These items were from Ryff’s (1989) positive relations with others and autonomy dimensions. The concepts of extended self-identity and diunital logic (Myers, 1993) were also represented in this factor. Specifically, this factor involved using supportive relationships to guide decision-making (extended self- identity) while also believing that relationships do not need to deter from achieving personal goals (diunital logic).
Thus, after restructuring of Ryff’s 39-item measure the two factors that emerged reflected concepts of Optimal Theory. Relationally-Orientated Decision Making coincides with Myers’ (1993) extended self-identity and diunital logic while Confident
Future Outlook reflects self-knowledge. Given that the original factor structure of Ryff’s
PWB (1989) was not replicated in this population, the two factor model is likely a better factor structure of PWB for this population.
Results of the regression analysis further confirmed the importance of an optimal worldview for Black women’s wellness. Confident Future Outlook and Relationally-
Oriented Decision Making significantly related to Black women’s mental health symptoms. This suggested that greater coping with future challenges and greater balance of self and others when making decisions predicted lower depressive symptoms and distress for Black women. Even more important, optimal beliefs related to Black
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women’s mental health symptoms above and beyond Confident Future Outlook and
Relationally-Oriented Decision Making.
Overall, both PWB and optimal beliefs uniquely related to Black women’s mental health symptoms. Specifically, higher endorsement of optimal beliefs, Confident Future
Outlook, and Relationally-Oriented Decision Making was related to lower depressive symptoms and lower distress for Black women. These results suggest that we need both to incorporate cultural factors (optimal beliefs) and individual factors (PWB) when measuring and exploring Black women’s mental health symptoms. Indeed, upon restructuring the factors, the two-factor model of Ryff’s PWB accounted for 10.1% of the variance in mental health symptoms, and optimal beliefs accounted for 7.7% of the variance.
There is a large amount of variance in mental health symptoms that is unaccounted for. Part of this unexplained variance could be due to additional variables that relate Black women’s mental health symptoms. Other intrapsychic variables that could explain additional variance are amount of critical consciousness (Freire, 1968;
Watts, Diemer, & Voight, 2011; Kagan, 2015), internalized racism (Molina & James,
2016; Speight, 2007), endorsement of the Strong Black Women stereotype (Beauboeuf-
Lafontant, 2009; Donovan & West, 2015; Lewis et al., 2013) or endorsement other stereotypes society places on Black women (Brown, White-Johnson, Griffin-Fennell,
2013; Brown-Givens & Monahan, 2005; Speight et al., 2012). It is also important to consider cultural- and societal-level variables that could explain additional variance in
Black women’s mental health symptoms, such as racism, sexism, and gendered-racism
(Moradi & Subich, 2003; Perry et al., 2012; Perry et al., 2013; Yang, 2015). Other
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societal-level variables that could explain variance are poverty (Cutrona et al., 2000;
Postmes & Branscombe, 2002; Snowden, 2014) and exposure to police violence against
Black women and the Black community (Cooper, Moore, Gruskin, & Krieger, 2004;
Staggers-Hakim, 2016).
Given the relationship of Confident Future Outlook, Relationally-Oriented
Decision Making, and optimal beliefs to Black women’s wellness and mental health symptoms, the next section discusses how these variables corresponded with gendered- racial identity.
Relationships among Gendered-Racial Identity and Wellness
Results of the canonical correlation analysis (CCA) suggested that optimal beliefs are especially important for Black women who view their identity as a Black woman positively and believe it is a central part of their self-image. While public regard was not significant in the CCA, there was a significant relationship among high private regard, high centrality and high amounts of optimal beliefs, Confident Future Outlook, and
Relationally-Oriented Decision Making. In other words, endorsement of optimal beliefs was greatest among Black women who held positive beliefs about their gendered-racial identity and viewed this identity as central to who they are.
The relationship among cultural identity and wellness is well-established in the literature (Brown & Keith, 2003; Speight, et al., 2009; Speight, et al., 2012), although the current study was one of a few studies to explore the connection between intersectional identities and wellness in Black women specifically. By taking a within-groups approach, this study was able to explore how wellness and racial-gendered identity (e.g. public regard, private regard, centrality) may converge in unique ways for Black women. First,
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public regard was not related to wellness in this sample. The next section discusses the lack of significant findings for public regard. Second, as stated above, optimal beliefs appeared to be especially relevant for Black women who held positive beliefs about their identity as a Black woman (e.g. high private regard) and believed this identity was central to their self-image (e.g. high centrality).
Overall, Black women who viewed their gendered-racial identity positively and as central to who they are, experienced a high amount of wellness that was not related to other people’s views of their identity. While there appears to be a relationship among private regard, centrality, and optimal beliefs/wellness for Black women, this study cannot speculate about the causal relationship among these constructs (e.g. does greater endorsement of optimal beliefs lead to higher private regard? Or does high private regard lead to greater endorsement of optimal beliefs?). When counseling Black women who report their gendered-racial identity as an important aspect of who they are, psychologists are encouraged to focus on enhancing private regard and optimal beliefs as these may be the most central identity and wellness variables among Black women with high centrality. Additional recommendations for practice are discussed in the Implications for
Practice section.
Integration and Summary of Results
Taken together, results of the content analysis, regression, factor analysis, and canonical correlation analysis suggested two patterns about Black women’s wellness.
First, Black women’s wellness is a multifaceted construct that is strongly aligned with
Myer’s Optimal Theory. Consistently throughout qualitative and quantitative responses, optimal beliefs appeared to be underlying how this population defined wellness. In
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particular, the dimensions of liberation, a spiritual sense of reality, self-knowledge, diunital logic, and extended self-identity were present throughout the qualitative and quantitative results.
The combined results of this study suggested a restructured version of Ryff’s
PWB relates to Black women’s mental health symptoms and gendered-racial identity.
However, qualitative and quantitative results support the unique role of Optimal Theory in how Black women define wellness, beyond what is offered by PWB. Indeed, Black women emphasized the role of liberation in their wellness, which is best captured through
Myer’s theory and lacking from Ryff’s theory. Also, endorsement of optimal beliefs was related to fewer mental health symptoms for Black women above and beyond Ryff’s
PWB. Thus, Optimal Theory (Myers, 1993) appears to offer unique elements beyond
PWB which is congruent with Black women’s self-report that optimal beliefs are key to their definition of wellness. The importance of a culturally-relevant model of wellness for
Black women (Brown & Keith, 2003; Constantine & Sue, 2006; Frazier, et al., 2006;
Myers and Speight; 2010) and the lack of a six-factor structure of PWB for minority populations (Christopher, 1999; Mehrotra et al., 2013) is congruent with the existing literature.
Another pattern to emerge across the analyses in this study was public regard, or beliefs about how other people view Black women, were not related to Black women’s wellness or mental health symptoms. Public regard was not significantly correlated with any other variable in this study and was also not a significant related to wellness in the canonical correlation analyses. Additionally, results of both the qualitative analysis and the exploratory factor analysis suggested that Black women saw a supportive
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environment and trusting friends as key to their wellness. However, trusting friends and an extended self-identity is different from public regard, which is what a Black woman believes other people think about her identity. Thus, across qualitative and quantitative results, relationships were important to Black women’s wellness, but public regard was not.
This is consistent with non-significant results for public regard in other studies that tested the relationships among Seller’s MMRI, Ryff’s PWB, and wellness (Seaton et al., 2011; Sellers et al., 2006). These studies and the current study found that public regard was not related to Ryff’s PWB, whereas private regard was significantly related to
PWB. Studies that did not use PWB but used other measures of wellness (e.g., life satisfaction) also found public regard was not related to Black women’s wellness
(Rowley et al., 1998; Settles et al., 2010; Yap et al., 2011). Thus, there is a growing trend in the literature that public regard may not have a strong influence on Black women’s wellness whereas other aspects of identity, specifically private regard and centrality, may have more impact on wellness for this population. It is possible that the relationship between public regard and wellness may be more complex than what the current study tested. It may be that variables may moderate the relationship between public regard and wellness, such as internalized racism, experiences of gendered-racism, and/or critical consciousness, although more research is needed.
The lack of findings about public regard makes sense for the current sample of
Black women. First, rather than letting other people’s views of their group influence their wellness, Black women in this study emphasized how trusting relationships with close friends and family beliefs influenced their wellness. Additionally, Black women in this
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sample might have related less to public regard because they prioritized a holistic view of wellness throughout their responses rather than viewing a single thing (e.g., public regard) as the source of their well-being and mental health. This holistic worldview and emphasis on self-knowledge rather than a materialistic or external worldview is consistent with how Black women viewed optimal beliefs as important to their wellness.
Finally, pubic regard may have been less influential on the wellness of this sample because they discussed the importance of liberation to their wellness, rather than the viewpoints of others’ as important.
Black women in this study may have been less concerned with other people’s beliefs about them as a group and more concerned with the tangible reality of how their group is treated. Rather than focusing on how society’s beliefs about their group impact them, they were focused on the impact of society’s actions: by equal access to resources, ending gender and racial oppression, and the ability to experience wellness without hindrances. In fact, it can be considered a strength that the Black women in this sample are not reliant upon the public regard of a racist and sexist society to experience wellness.
They are self-determining and confident in their gendered-racial identity, reflecting
Myers’ intrinsic self-worth rather than defining their wellness on external, societal views.
This study offers growing evidence for the role of optimal beliefs and gender- racial identity (especially private regard) as defining and influencing Black women’s wellness and mental health symptoms. In addition to these contributions to the literature it is important to acknowledge the limitations of the current study as well as identity next steps for both research and practice.
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Limitations and Future Directions
It is important to recognize the limitations of the current study. First, data for this study was obtained through self-report measures. The self-report nature of the questionnaires and open-ended questions may have affected results. It could be worthwhile to conduct semi-structured interviews with participants or to corroborate data with friends or family member’s view on participants’ wellness. Despite this limitation, this study had a substantial strength in that it used of sample of African American women, both community members and university students, from a wide variety of educational and geographic backgrounds. Another limitation of this study is that initial dataset appeared to have robot responses in it. While there was a meticulous process for deleting robot responses (see chapter 4), it remains unknown if any robot responses were kept in the dataset or if any real responses were deleted.
A third limitation involves the constructs’ measurements. This study changed the original items of the MIBI in order to approximate intersectionality of race and gender identities. While this has been done in other studies with other measures (see Thomas et al., 2008) the current study is the first to change the stems of the MIBI. Thus, it remains unclear the extent to which an intersectional, gendered-racial identity was truly captured by this measure.
A final limitation of this study is that it is correlational in nature and the results cannot provide information about the causal links among gendered-racial identity, optimal worldview, and mental health symptoms. While the results demonstrated that these constructs are related, and that there are unique relationships among these variables depending on gendered-racial identity, the directional nature of these relationships
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remains unclear. For instance, it is unknown at this point if having high centrality and private regard leads to high amounts wellness (defined as optimal beliefs), or if endorsing optimal beliefs makes Black women more likely to view their identity positively and as central to who they are.
Implications for Research
Building off the limitations of the current study, there are several recommendations for future research. Currently an intersectional measure of gendered- racial identity does not exist and the research literature would benefit from the creation and validation of such a measure. More specifically regarding identity and the MMBI
(Sellers et al., 2006), more research is needed on the influence of private regard in Black women’s wellness, especially given the key role positive beliefs played in predicting lower mental health symptoms for this population. Relatedly, more understanding about public regard is needed, including more research on the role, if any, it plays in Black women’s wellness and when public regard might be a more impactful part of gendered- racial identity. For instance, does public regard have a greater influence on Black women’s wellness when factoring in current political events and/or violence against
Black men and women? Could public regard be more influential in the relationship of identity and mental health symptoms when considering the extent to which a Black woman is exposed to media stereotypes or news coverage?
Based on the results of the current study, it is recommended to utilize the two- factor structure of Ryff’s PWB with a sample of Black women. This two-factor model had strong factor loadings, reliability, and made theoretical sense. Other studies had difficulty replicating the original six-factor model and recommend adapting Ryff’s
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SPWB for culturally diverse groups (Christopher, 1999; Frazier et al., 2006; Mehrotra et al., 2013). Results of the current study suggested researchers could consider using both the two-factor PWB model and optimal beliefs to operationalize wellness for Black women. Using optimal beliefs in addition to an intrapsychic measure such as PWB is consistent with suggestions to use culturally-congruent models of wellness (Constantine
& Sue, 2006; Daraei, 2013; Frazier, et al., 2006), especially when exploring Black women’s wellness (Brown & Keith, 2003; Myers & Speight; 2010). This is consistent with current literature in which both individual and societal stressors impact Black women’s mental health (Perry et al., 2013) and in which optimal beliefs related to greater wellness outcomes in Black women specifically (Watt 2003).
Further research could be done with optimal beliefs, specifically to conduct a factor analysis on the BSAS and possibly create subscales for each dimension of an optimal worldview. Possible subscales are identified by Montgomery et al., (1990) but only Neblett and Carter (2012) have done subscale analysis with BSAS and they only used the intrinsic self-worth subscale with poor results. The creation and validation of subscales in the BSAS would allow researchers to explore if there are specific optimal beliefs that are more influential to Black women’s wellness and mental health symptoms.
For instance, does extended self-identity, diunital logic, or self-knowledge uniquely predict Black women’s mental health symptoms or are some of these optimal beliefs more predictive than others? The BSAS could also be reworked to measure endorsement of a suboptimal worldview specifically, rather than just assuming that low scores on the
BSAS reflect of suboptimal beliefs.
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Findings from the current study, and from ideas in this section on future directions, provide information for psychologists working with Black women in clinical settings. The implications of the current study are discussed next.
Implications for Practice
Results of this study provided several suggestions for counseling psychologists and their work with Black women. First, it is important to assess all clients’ gendered- racial identity, but this is especially the case when working with Black women. Based on
Sellers and colleagues (2006; 2007) MMRI, psychologists might ask the following questions: How do you view yourself as a Black woman (e.g. private regard)? How do you view other Black women (e.g. public regard)? How do you think other people (e.g. strangers, overall society etc…) view Black women? Tell me about how your identity as a Black woman does or does not play in your life? How important, or essential, is your identity as a Black woman to who you are or how you define yourself (e.g. centrality)?
What have you been told about being a Black woman by other Black women (by society? close friends?)?
Responses to these questions can inform how psychologists conceptualize wellness for their Black women clients. For instance, study results suggested that if a client states her gender and racial identities are highly important to her self-image and that she views herself as a Black woman positively, she is likely to: define her health in terms of optimal beliefs, to value continual self-growth and challenge (e.g. Confident
Future Outlook), and view personal goals and decision-making in the context of relationships (e.g. Relationally-Oriented Decision Making). This could mean focusing on her extended self-identity while also engaging in diunital logic to encourage her to care
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for herself and others. Such a client may benefit from exploring how she views herself, other people, and the world to understand the extent to which her worldview is optimal
(e.g. holistic, spiritually-connected) or suboptimal (e.g. segmented and materially- focused). In general, a Black woman client with high private regard and centrality may be likely to believe she is getting better and experiencing wellness when she embodies optimal beliefs. This would require many counseling psychologists to reconsider the criteria they use to decide when a client is ready to terminate or when a client is ‘well’. If we continue to operationalize wellness from an individualistic, intrapsychic perspective, we will be providing a disservice to our Black women clients that may view their wellness in terms of optimal beliefs.
Thus, psychologists must expand our definitions of wellness to include, if not prioritize, cultural values. Black women emphasized wellness as an integration of multiple domains, including self-care, spirituality, giving back to others, financial stability, supportive relationships, and liberation/empowerment. Based off of this definition, psychologists might consider assessing clients’ functioning based on the above domains in addition to assessing the mental health symptoms clients endorse. For instance, practitioners can inquire about involvement in the community, current finances, social support network, current and previous spiritual/religious practices, and sense of agency as ways to understand the extent to which a Black woman client is experiencing wellness. A multidimensional, culturally-informed perspective on wellness could also be incorporated into treatment planning, where the goals/objectives would no longer only be
“rates depression on a 5 out 10 scale” but also “client participates in community activities twice a month”. Such a change reflects not only broadening our view of wellness to be
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more congruent with how Black women define wellness, but also shifting our practice away from decreasing mental health symptoms towards increasing their wellness.
In the clinical examples above Black women clients entered therapy already expressing positive beliefs about being a Black women. It is important to recognize that racism, patriarchy, and gendered-racism often result in Black women internalizing negative beliefs about themselves (Brown & Keith, 2003; Speight, 2007; Speight et al.,
2012; Williams & Williams-Morris, 2000). Thus, not all Black women may enter therapy with high private regard. The current study suggested that psychologists may find it beneficial to work with such clients on increasing positive beliefs about themselves because high private regard was correlated with wellness for the sample in this study.
Psychologists can increase positive regard by helping clients to 1) identity negative societal stereotypes and 2) challenge internalized gendered-racism (Speight et al., 2012).
On way psychologists can help Black women challenge internalized gendered-racism is to review self-help and psychoeducational resources with clients, including resources on
Black feminism and womanism and books on the myth of the strong Black woman.
Overall, careful attunement to clients’ gendered-racial identity, specifically centrality and private regard, can help practitioners identity what interventions are most likely to contribute to wellness.
In addition to raising their Black female clients’ critical consciousness about stereotypes and internalized gendered-racism, psychologists must also raise their own awareness of these issues. Utilizing psychoeducational resources could be helpful to work towards understanding the lived experiences of Black women in the United States.
Psychologists must also challenge their own internalized beliefs and stereotypes about
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Black women. This work can be accomplished through self-reflection, supervision, diversity trainings, and many other avenues. It is important that as psychologists we are engaging in the same cultural self-reflection and critical consciousness work we are asking our clients to engage in, especially when working with Black women because
African-centered Optimal Beliefs were highly related to wellness for this population.
Psychologists could also conduct Belief Systems Analysis (Myers, 1991; 1993;
Myers & Speight, 2010) an approach to therapy that aims to increase optimal beliefs.
Therapy could include psychoeducation to Black women, and other clients, about the constructs of optimal and suboptimal beliefs. This intervention could include an exploration of which specific beliefs and overall worldview they find themselves adhering to the most. It could be worthwhile to inquire about which beliefs the client most aligned with in the past, which beliefs they adhere to most currently, and which beliefs they see as most influential to their growth/future. This line of inquiry aligns with the developmental perspective of counseling psychology and acknowledges that the centrality and regard of Black women’s identities are not stagnant over time.
Psychologists could also explore with clients how endorsement of various beliefs, optimal and suboptimal, impacts their overall wellness and mental health symptoms, thus increasing Black women’s insights into how their worldview influences them. Providing this information could help a client better understand their current health and also provides them with a guideline for how to move towards wellness by altering aspects of their worldview.
Finally, an essential part of psychologists’ work with Black women’s is the creation of their liberation and empowerment. Liberation includes the equal distribution
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of resources in society (Prilleltensky & Fox, 2007), engaging in dialogue and informed action that is co-created with marginalized communities (Freire, 1968), and undoing the suboptimal system currently in place in dominant society (Myers, 1991; 1993). As psychologists it is necessary, but not sufficient, for us to be knowledgeable about gendered-racial identity and how that relates to Black women’s endorsement of optimal beliefs. Beyond multicultural knowledge and awareness, we must engage in efforts to liberate and empower Black women, for without liberation from oppression they cannot truly experience wellness. Indeed, many studies confirm that societal oppression and stereotypes negatively impact Black women’s wellness (Brown & Keith, 2003; Cadilupo
& Kim, 2014; Fischer & Bolton Holz, 2010; Moradi & Subich, 2003; Perry et al., 2013;
Perry, et al., 2012; Sue & Sue, 2008). Thus, in order for psychologists to provide competent care to Black women, we must go beyond multicultural knowledge to engage in social justice action (Vera & Speight, 2003).
Given that oppression and wellness occurs at individual, relational, and societal levels (Prilleltensky & Prilleltensky, 2003), psychologists must work at each of these levels to create change. We can engage our individual clients in consciousness raising, whether that means helping Black women externalize gendered-racist messages or challenging the discriminatory language of clients who have race or gender privilege. In our relationships with trainees, colleagues, supervisees, and supervisors, we can recognize our own power and privilege, challenge biases and suboptimal worldviews, and advocate for Black women to receive competent care and equitable opportunities.
We are also called to create change at societal and environmental levels (Vera &
Speight, 2003). In our professional associations, universities, and the larger society we
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can be the voice with Black women advocating to be heard. We must also upend the suboptimal system currently in place at the environmental, professional, and societal levels we operate in (Myers, 1991; 1993). This includes challenging the suboptimal worldview within counseling psychology and the field of psychology overall. If we are to create liberation, as the results of this study suggest is necessary for Black women’s wellness, we need to eliminate discriminatory diagnostic and treatment practices of marginalized groups and correct the belief that mental health is the result of intrapsychic weakness rather than societal/cultural oppression. Creating liberation also requires undoing the societal values that establish people’s worth on material goods and external criteria (e.g. skin color, gender) along with upending the systems of power that uphold these suboptimal values, including racism, patriarchy, and the prison-industrial complex
(Alexander, 2010; Collins, 2000, Myers, 1993).
In accordance with the results of this study, the reduction of oppression at individual, collective, environmental, and societal levels is the enhancement of wellness for Black women. Counseling psychologists are called upon and uniquely positioned to do both: reduce oppression of Black women and foster their wellness and liberation.
Conclusion
The current study added to the literature by listening to the voices of Black women to form a definition of wellness. Consistently across qualitative and quantitated results, Black women’s wellness incorporates cultural values, optimal beliefs, and liberation. Psychologists cannot continue to impose individualistic models of wellness onto Black women and measure their wellness solely through intrapsychic constructs like
PWB. We need both culturally-informed individual wellness models, along with cultural
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models of wellness such as Optimal Theory (Myers, 1991; 1993). Optimal beliefs aligned well with how Black women defined their own wellness, related to lower mental health symptoms in this population, and was strongly related to their gendered-racial identity.
While more research is needed on the individual and cultural facets of Black women’s wellness, the current findings can further empower psychologists with strategies to foster
Black women’s wellness. The results are clear, we cannot ignore that an optimal worldview, positive private regard for gendered-racial identity, and liberation from societal oppression is essential to Black women being, and staying, well.
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APPENDICES
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APPENDIX A
PARTICIPANT INFORMED CONSENT FORM
Title of Study: Relationships among Black women’s wellness, gendered-racial identity, and mental health symptoms
Introduction: You are invited to participate in a research study being conducted by Stephanie Dykema, M.Ed., a doctoral candidate in Counseling Psychology at The University of Akron, under the direction of Dr. Ingrid Weigold.
Purpose: The purpose of this study is to explore Black women’s wellness, mental health, and beliefs about their racial and gender identity. I am planning to collect data from 150 to 200 people.
Eligibility: To be eligible to participate, you need to identify as a Black woman and be 18 years of age or older.
Procedures: If you choose to participate, you will complete an on-line survey that will take between 20 and 25 minutes of your time.
Risks and Discomforts: Participation in this study is not believed to be associated with any significant risks or discomfort and no specific liability plan is offered.
Benefits: You will receive no direct benefits from participation. However, your participation may help researchers understand Black women’s wellness and cultural beliefs and attitudes towards their race and gender.
Incentive to Participants: Every participant that completes this survey will receive a $5 gift card. If you are a student at The University of Akron participating through HPR, you will receive 1 HPR credit for completing the survey.
.
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Right to Refuse or Withdraw: Taking part in this study is voluntary. If you decide that you do not want to participate, you can withdraw from the study at any time.
Anonymous and Confidential Data Collection: The information you provide will be kept anonymous and your name will not be associated with your responses to the survey. Any papers resulting from this study will report data in an aggregate mannerWho to Contact with Questions: If you have any questions about this research, do not hesitate to email Stephanie Dykema at [email protected] or to contact her advisor, Dr. Ingrid Weigold, at [email protected]. This project has been reviewed and approved by The University of Akron Institutional Review Board. If you have any questions about your rights as a research participant, you may call the IRB at (330) 972-7666.
Acceptance and Consent: I have read the information provided and all of my questions have been answered. I voluntarily agree to participate in this study. Checking “Yes” below will serve as my consent. I may print a copy of this consent statement for future reference.
_____ Yes, I consent to participate in this study, and I am at least 18 years old.
_____ No, I decline to participate and wish to exit this study.
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APPENDIX B
UA STUDENT PARTICIPANT INVITATION
Dear Fellow UA Students,
My name is Stephanie Dykema, and I am a doctoral candidate at the University of Akron. I would like to invite you to participate in my dissertation research, which examines Black women’s wellness and gender and racial identity.
To be eligible to participate, you need to identify as a Black woman and be 18 years or older.
If you choose to participate, you will complete a 20- to 25-minute online survey. At the end, you will have the option to provide your name and University of Akron e-mail address to receive course credit for your participation. The information you provide will be kept confidential and your name will not be associated with your responses to the survey.
If you would like to participate in this study, please click on the web link provided below. It will direct you to the online survey developed for the purpose of this study.
If you have any questions, please do not hesitate to contact the primary researcher, Stephanie Dykema, at [email protected].
Thank you in advance for your time!
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APPENDIX C
COMMUNITY PARTICIPANT WEBSITE INVITATION
Dear Fellow Community Member,
My name is Stephanie Dykema, and I am a doctoral candidate. I would like to invite you to participate in my dissertation research, which examines Black women’s wellness and gender and racial identity.
To be eligible to participate, you need to identify as a Black woman and be 18 years or older.
If you choose to participate, you will complete a 20- to 25-minute online survey. Every person who participates will receive a $5 gift card.
If you would like to participate in this study, please click on the web link provided below. It will direct you to the online survey developed for the purpose of this study.
If you have any questions, please do not hesitate to contact the primary researcher, Stephanie Dykema, at [email protected].
Thank you in advance for your time!
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APPENDIX D
NON-UA STUDENT PARTICIPANT E-MAIL INVITATION
Hello [Name of Contact], [email]
My name is Stephanie Dykema, and I am a doctoral candidate at The University of Akron. I am currently completing my dissertation research under the direction of Dr. Ingrid Weigold. My study examines Black women’s wellness and gendered-racial identity. As a part of my recruitment strategy, your department or student organization was selected to receive my request for participants.
I would be grateful if you would forward the e-mail below to the listserv for the [Name of Department or Student Organization]. The e-mail below contains information on how to complete my survey.
If this request has reached you incorrectly, please forward this e-mail to the correct contact for your department or student organization.
Please contact me with any questions at [email protected].
Sincerely,
Stephanie Dykema
Please forward the following information to your listserv:
Hello,
My name is Stephanie Dykema, and I am a doctoral candidate. I would like to invite you to participate in my dissertation research, which examines Black women’s wellness and gender and racial identity.
205
To be eligible to participate, you need to identify as a Black woman and be 18 years or older.
If you choose to participate, you will complete a 20- to 25-minute online survey. Every person who participates will receive a $5 gift card. If you would like to participate in this study, please click on the web link provided below. It will direct you to the online survey developed for the purpose of this study.
If you have any questions, please do not hesitate to contact the primary researcher, Stephanie Dykema, at [email protected].
Thank you in advance for your time!
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APPENDIX E
DEBRIEFING STATEMENT
Thank you for your participation in this study.
The aim of this study is to determine how various attitudes, feelings, and beliefs towards one’s race and gender are, or are not, related to one’s wellness and mental health. In particular, this study looked at wellness that includes psychological, spiritual, relational, and cultural aspects. The overall goal of this study is to create a broad, holistic definition of wellness for Black women.
Previous research suggests that wellness is not limited to a person’s satisfaction with life or feelings towards themselves as an individual. Wellness also involves a person’s spiritual/religious beliefs (if applicable), relationships with other people, and the support/strength within their community. Additionally, people hold various beliefs about their race and gender. These beliefs can be related to wellness in different ways for different people. Attitudes towards one’s race and gender depend on the individual and may change over time.
Your participation is not only greatly appreciated by the researchers involved, but the data collected could possibly help psychologists, counselors and other helping professionals to better understand what values, beliefs, and attitudes towards one’s race and gender are especially related to Black women’s wellness. Thus, our hope is that helping professionals will be better able to empower Black women and foster their well- being.
If you have experienced any questions, concerns, or distress in the course of your participation in this study, and/or if you are interested in learning more about how counselors can help you experience more wellness, please contact a local counseling
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agency in your area or at the university where you are a student. You can also call the 24- hour national help hotline at 1-800-273-TALK (8255).
If you have any questions about this study, please contact us. You can contact Stephanie Dykema at [email protected], or her advisor, Ingrid Weigold at [email protected].
If you know someone else you may be eligible and interested in participating in this study, please e-mail them the information below. E-mailing the survey link to another possible participant is voluntary and not required to receive your gift card. If you choose to e-mail the survey information to another eligible participant, we urge you not to discuss the details of this study or what it measures.
If you would like to receive your $5 gift card please click on this link. This link will take you to a separate page where you can enter your e-mail address. Your gift will be sent to you electronically at this e-mail address. Your contact information will not be connected to your survey responses.
Thank you!
Copy and paste the information below into an e-mail to someone you know who is an eligible participant (i.e., Black woman, 18 years of age or older):
Hello Friend,
I just completed this survey and I thought you might be interested in participating as well. The study examines Black women’s wellness and gender and racial identity. It is the dissertation research of Stephanie Dykema, who is a doctoral candidate at The University of Akron. To be eligible to participate, you need to identify as a Black woman and be 18 years or older. If you choose to participate, you will complete a 20- to 25-minute online survey.
Please consider participating as I did. Every person who participates can receive a $5 gift card.
If you would like to participate in this study, please click on the web link provided below. It will direct you to the online survey developed for the purpose of this study.
If you have any questions, please do not hesitate to contact the primary researcher, Stephanie Dykema, at [email protected].
Thank you in advance for your time!
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APPENDIX F
RECRUITMENT UNIVERSITIES
HISTORICALLY BLACK COLLEGES AND UNIVERSITIES (HBCUs) 20 HBCUs with the highest number of Black women enrolled in 2013-2014 academic year:
1. Florida Agricultural and Mechanical University 2. Jackson State University 3. Howard University 4. North Carolina A & T State University 5. Texas Southern University 6. Southern University and A & M College 7. Prairie View A & M University 8. North Carolina Central University 9. Tennessee State University 10. Norfolk State University 11. Morgan State University 12. Alabama State University 13. Bowie State University 14. Fayetteville State University 15. Grambling State University 16. Virginia State University 17. Hampton University 18. Winston-Salem State University 19. Albany State University 20. Alabama A & M University
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PREDOMINATELY WHITE INSTITUTIONS (PWIs) 20 PWIs with highest number of Black women enrolled in 2013-2014 academic year:
1. Houston Community College 2. Broward College 3. Georgia State University Prince George's Community College 4. Georgia Perimeter College 5. Community College of Philadelphia 6. Cuyahoga Community College 7. Florida State College at Jacksonville 8. Delgado Community College 9. The Community College of Baltimore County 10. Northern Virginia Community College 11. Troy University 12. Central Piedmont Community College 13. Southwest Tennessee Community College 14. Palm Beach State College 15. Valencia College 16. University of Memphis 17. Hinds Community College 18. Saint Leo University 19. Nova Southeastern University
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APPENDIX G
DEMOGRAPHIC QUESTIONNAIRE
Please answer what best describes you:
1. What is your age: _____
2. What is your gender: ____ Man ____ Woman ____ Transgender ____ Other, please specify: ______
3. What is your sexual orientation? ____ Lesbian ____ Gay ____ Bisexual ____ Heterosexual ____ Other, please specify: ______
4. What is your race: ____ African-American ____ Black ____ Biracial, please specify: ______Other, please specify: ______
5. What is your ethnicity (e.g. American, Haitian, Caribbean, etc…): ______
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6. Do you have children? ____ No ____ Yes, please specify how many: ______
7. How do you identify in terms of religion/spirituality? ____ Christian (Protestant) ____ Catholic ____ Mormon (Church of Jesus Christ of Latter-day Saints/LDS) ____ Jehovah’s Witness ____ Other, please specify: ______
8. What geographic region of the United States do you currently live in?: ____ Northeast ____ Midwest ____ South ____ West
9. What is the highest level of education you have completed? ____ Some high school ____ High school diploma or GED ____ Some college ____ Associate’s Degree ____ Bachelor’s Degree ____ Masters Degree ____ Doctoral Degree ____ Other, please specify: ______
10. What is your current employment status? ____ Full time employment ____ Part time employment ____ Unemployed / Looking for work ____ Unemployed / Not looking for work ____ Self-employed ____ Student ____ Retired ____ Other, please specify: ______
11. What is your annual household income? ____ Less than $15,000 ____ $15,001 – $35,000 ____ $35,001 – $50,000 ____ $50,001 – $75,000 ____ $75,001 – $100,000 ____ $100,001+
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12. How did you arrive at this survey?: ____ University of Akron Sona Systems/course credit ____Website, please specify: ______A friend sent me the link ____ E-mail from university department ____ E-mail from student organization ____ Other, please specify: ______
13. Have you already completed this survey previously?: (your answer to this question will not affect any time compensation for participating ____ Yes, I have completed this survey before ____ No, this is my first time completing this survey
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APPENDIX H
MULTIDIMENSIONAL INVENTORY OF BLACK IDENTITY
Strongly Strongly Disagree Neutral Agree
1. Overall, being a Black woman has very little to do 1 2 3 4 5 6 7 with how I feel about myself. (R)
2. I feel good about Black women. 1 2 3 4 5 6 7
3. Overall, Black women are considered good by 1 2 3 4 5 6 7 others.
4. In general, being a Black woman is an important 1 2 3 4 5 6 7 part of my self-image.
5. I am happy that I am a Black woman. 1 2 3 4 5 6 7
6. In general, others respect Black women. 1 2 3 4 5 6 7
7. My destiny is tied to the destiny of other Black 1 2 3 4 5 6 7 women.
8. I feel that Black women have made major 1 2 3 4 5 6 7 accomplishments and advancements.
9. Most people consider Black women, on the average, 1 2 3 4 5 6 7 to be more ineffective than other racial-gender groups. (R)
10. Being a Black woman is unimportant to my sense of 1 2 3 4 5 6 7 what kind of person I am. (R)
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11. I often regret that I am a Black woman. (R) 1 2 3 4 5 6 7
12. Black women are not respected by the broader 1 2 3 4 5 6 7 society. (R)
13. I have a strong sense of belonging to Black women. 1 2 3 4 5 6 7
14. I am proud to be a Black woman. 1 2 3 4 5 6 7
15. In general, other groups view Black women in a 1 2 3 4 5 6 7 positive manner.
16. I have a strong attachment to other Black women. 1 2 3 4 5 6 7
17. I feel that Black women have made valuable 1 2 3 4 5 6 7 contributions to this society
18. Being a Black woman is an important reflection of 1 2 3 4 5 6 7 who I am.
19. Society views Black women as an asset. 1 2 3 4 5 6 7
20. Being a Black woman is not a major factor in my 1 2 3 4 5 6 7 social relationships. (R)
Centrality Scale: Items 1, 4, 7, 10, 13, 16, 18, 20 Private Regard Subscale: Items 2, 5, 8, 11, 14, 17 Public Regard Subscale: Items 3, 6, 9, 12, 15, 19
(R) items should be reverse coded.
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APPENDIX I
SCALES OF PSYCHOLOGICAL WELL-BEING (39-ITEM VERSION)
INSTRUCTIONS: The following set of questions deals with how you feel about yourself and your life. Please remember that there are no right or wrong answers.
Strongly Moderately Slightly Slightly Moderately Strongly Disagree Disagree Disagree Agree Agree Agree
1. I am not afraid to voice my opinions, even when 1 2 3 4 5 6 they are in opposition to the opinions of most people.
2. When I look at the story of my life, I am pleased 1 2 3 4 5 6 with how things have turned out
3. I often feel lonely because I have few close friends 1 2 3 4 5 6 with whom to share my concerns. (R)
4. In general, I feel I am in charge of the situation in 1 2 3 4 5 6 which I live.
5. I feel good when I think of what I've done in the 1 2 3 4 5 6 past and what I hope to do in the future.
6. In general, I feel that I continue to learn more about 1 2 3 4 5 6 myself as time goes by.
7. I tend to worry about what other people think of me. 1 2 3 4 5 6 (R)
8. In general, I feel confident and positive about 1 2 3 4 5 6 myself.
9. I don't have many people who want to listen when I 1 2 3 4 5 6 need to talk. (R)
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Slightly Moderately Strongly Moderately Slightly Strongly Disagree Agree Disagree Disagree Agree Agree
10. The demands of everyday life often get me down. 1 2 3 4 5 6 (R)
11. I have a sense of direction and purpose in life. 1 2 3 4 5 6
12. I tend to be influenced by people with strong 1 2 3 4 5 6 opinions. (R)
13. Given the opportunity, there are many things about 1 2 3 4 5 6 myself that I would change. (R)
14. I feel like I get a lot out of my friendships. 1 2 3 4 5 6
15. I am quite good at managing the many 1 2 3 4 5 6 responsibilities of my daily life.
16. I don't have a good sense of what it is I'm trying to 1 2 3 4 5 6 accomplish in life. (R)
17. I don't want to try new ways of doing things--my 1 2 3 4 5 6 life is fine the way it is. (R)
18. I have confidence in my opinions, even if they are 1 2 3 4 5 6 contrary to the general consensus.
19. I like most aspects of my personality. 1 2 3 4 5 6
20. It seems to me that most other people have more 1 2 3 4 5 6 friends than I do. (R)
21. If I were unhappy with my living situation, I would 1 2 3 4 5 6 take effective steps to change it.
22. I enjoy making plans for the future and working to 1 2 3 4 5 6 make them a reality.
23. I think it is important to have new experiences that 1 2 3 4 5 6 challenge how you think about yourself and the world.
24. It's difficult for me to voice my own opinions on 1 2 3 4 5 6 controversial matters. (R)
25. In many ways, I feel disappointed about my 1 2 3 4 5 6 achievements in life. (R)
26. I have not experienced many warm and trusting 1 2 3 4 5 6 relationships with others. (R)
27. I have difficulty arranging my life in a way that is 1 2 3 4 5 6 satisfying to me. (R)
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28. I am an active person in carrying out the plans I set 1 2 3 4 5 6 for myself.
29. When I think about it, I haven't really improved 1 2 3 4 5 6 much as a person over the years. (R)
30. I often change my mind about decisions if my 1 2 3 4 5 6 friends or family disagree.
31. For the most part, I am proud of who I am and the 1 2 3 4 5 6 life I lead.
32. I know that I can trust my friends, and they know 1 2 3 4 5 6 they can trust me.
33. I have been able to build a home and a lifestyle for 1 2 3 4 5 6 myself that is much to my liking.
34. I have the sense that I have developed a lot as a 1 2 3 4 5 6 person over time.
35. I am concerned about how other people evaluate the 1 2 3 4 5 6 choices I have made in my life. (R)
36. My aims in life have been more a source of 1 2 3 4 5 6 satisfaction than frustration to me.
37. For me, life has been a continuous process of 1 2 3 4 5 6 learning, changing, and growth.
38. I judge myself by what I think is important, not by 1 2 3 4 5 6 the values of what others think is important.
39. I gave up trying to make big improvements or 1 2 3 4 5 6 changes in my life a long time ago. (R)
AUTONOMY SUBSCALE: items 1, 7, 12, 18, 24, 30, 35, 38 SELF-ACCEPTANCE SUBSCALE: items 2, 8, 13, 19, 25, 31 POSITIVE RELATIONS WITH OTHERS SUBSCALE: items 3, 9, 14, 20, 26, 32 ENVIRONMENTAL MASTERY SUBSCALE: items 4, 10, 15, 21, 27, 33, PURPOSE IN LIFE SUBSCALE: items 5, 11, 16, 22, 28, 36 PERSONAL GROWTH SUBSCALE: items 6, 17, 23, 29, 34, 37, 39
(R) items should be reverse coded.
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APPENDIX J
OUTCOME QUESTIONNAIRE 45.2
Instructions: Looking back over the last week, including today, help us understand how you have been feeling. Read each item carefully and mark the box under the category which best describes your current situation. For this questionnaire, work is defined as employment, school, housework, volunteer work, and so forth.
Never Rarely Sometimes Frequently Almost Always
1. I get along well with others (R) 0 1 2 3 4
2. I tire quickly 0 1 2 3 4
3. I feel no interest in things 0 1 2 3 4
4. I feel stressed at work/school 0 1 2 3 4
5. I blame myself for things 0 1 2 3 4
6. I feel irritated 0 1 2 3 4
7. I feel unhappy in my marriage/significant 0 1 2 3 4 relationship
8. I have thoughts of ending my life 0 1 2 3 4
9. I feel weak 0 1 2 3 4
10. I feel fearful 0 1 2 3 4
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11. After heavy drinking, I need a drink the next 0 1 2 3 4 morning to get going. (If you do not drink, mark “never”)
12. I find my work/school satisfying (R) 0 1 2 3 4
13. I am a happy person (R) 0 1 2 3 4
14. I work/study too much 0 1 2 3 4
15. I feel worthless 0 1 2 3 4
16. I am concerned about family troubles 0 1 2 3 4
17. I have an unfulfilling sex life 0 1 2 3 4
18. I feel lonely 0 1 2 3 4
19. I have frequent arguments 0 1 2 3 4
20. I feel loved and wanted (R) 0 1 2 3 4
21. I enjoy my spare time (R) 0 1 2 3 4
22. I have difficulty concentrating 0 1 2 3 4
23. I feel hopeless about the future 0 1 2 3 4
24. I like myself (R) 0 1 2 3 4
25. Disturbing thoughts come into my mind that I 0 1 2 3 4 cannot get rid of
26. I feel annoyed by people who criticize my drinking 0 1 2 3 4 or drug use (If not applicable, mark “never”)
27. I have an upset stomach 0 1 2 3 4
28. I am not working/studying as well as I used to 0 1 2 3 4
29. My heart pounds too much 0 1 2 3 4
30. I have trouble getting along with friends and close 0 1 2 3 4 acquaintances
31. I am satisfied with my life (R) 0 1 2 3 4
32. I have trouble at work/school because of drinking or 0 1 2 3 4 drug use (If not applicable, mark “never”)
33. I feel that something bad is going to happen 0 1 2 3 4
34. I have sore muscles 0 1 2 3 4
35. I feel afraid of open spaces, of driving, or being on 0 1 2 3 4 buses, subways, and so forth.
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36. I feel nervous 0 1 2 3 4
37. I feel my love relationships are full and complete 0 1 2 3 4 (R)
38. I feel that I am not doing well at work/school 0 1 2 3 4
39. I have too many disagreements at work/school 0 1 2 3 4
40. I feel something is wrong with my mind 0 1 2 3 4
41. I have trouble falling asleep or staying asleep 0 1 2 3 4
42. I feel blue 0 1 2 3 4
43. I am satisfied with my relationships with others (R) 0 1 2 3 4
44. I feel angry enough at work/school to do something 0 1 2 3 4 I might regret
45. I have headaches 0 1 2 3 4
Symptom Distress subscale: 2, 3, 5, 6, 8, 9, 10, 11, 13, 15, 22, 23, 24, 25, 27, 29, 31, 33, 34, 35, 36, 40, 41, 42, 45 Interpersonal Relations subscale: 1, 7, 16, 17, 18, 19, 20, 26, 30, 37, 43 Social Roles subscale: 4, 12, 14, 21, 28, 32, 38, 39, 44
(R) Indicates reversed scored item so that (0=4), (1=3), (2=2), (3=1), (4=0)
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APPENDIX K
BELIEF SYSTEMS ANSLYSIS SCALE
Instructions: Please read each question carefully. Mark the most appropriate response to each question. Your responses are anonymous.
Completely Mostly Neither Mostly Completely Disagree Disagree Agree nor Agree Agree Disagree 1. The more important consideration when looking for 1 2 3 4 5 a job is not the money offered, but the people I would be working with (1, 4, 10)
2. English should be the only national language. If one 1 2 3 4 5 wants to live in this country, one should learn to speak the language; bilingualism is unimportant (R) (6, 8)
3. If I could make a choice, I would prefer to lead a 1 2 3 4 5 wealthy exciting life as oppose to one that is peaceful and productive in terms of helping other people (R) (1, 2, 4)
4. In order to know what’s really going on you need to 1 2 3 4 5 look at the scientific data rather than the individual’s personal experience (R) (5, 9)
5. Working at my job with meaning and purpose is 1 2 3 4 5 more important than the money received from the job (1, 2, 10)
6. Winning the lottery would solve all my problems 1 2 3 4 5 (R) (1, 2, 3, 10)
7. This country would be better off if we restricted 1 2 3 4 5 immigration to a very select few (R) (4, 8)
8. Welfare is a mistake; individuals must learn to help 1 2 3 4 5 themselves (R) (4)
9. When I meet with acquaintances on the street, I 1 2 3 4 5 note the type of clothes they are wearing and compare them to mine (R) (1, 10) 222
10. Race or nationality reveals more about an individual 1 2 3 4 5 than he/she may realize (R) (6, 10)
11. More than anything else, I am most convinced by 1 2 3 4 5 another’s opinion if he/she has statistics to back it up (R) (5, 9)
12. When I encounter new acquaintances at meetings or 1 2 3 4 5 work-related activities, I note the type of clothes they are wearing and am impressed if they are “dressed for success” (R) (1, 10)
13. When someone challenges my beliefs, I am eager to 1 2 3 4 5 set him/her straight (R) (3)
14. Pain is the opposite of love; in other words, the act 1 2 3 4 5 of love cannot cause pain (R) (7)
15. If a “friend” were to betray my confidence and tell 1 2 3 4 5 some other people a secret of mine, the best way for me to help him/her learn a lesson is for me to do the same thing to him/her when I get a chance (R) (3, 4)
16. If my opinion of my uncle has been different than 1 2 3 4 5 everyone else’s, then I must be perceiving him wrong (R) (7)
17. It is easy for me to see how the entire human race is 1 2 3 4 5 really a part of my extended family (8)
18. When considering all of the difficulties in life, I 1 2 3 4 5 have trouble seeing any meaning or order to it (R) (7)
19. I find myself worrying a lot about circumstance in 1 2 3 4 5 my life (R) (1, 10)
20. If I just had money, my life would be more 1 2 3 4 5 satisfying (R) (1, 2, 10)
21. If I were better looking, my relationship with others 1 2 3 4 5 would be more satisfying (R) (1, 10)
22. I feel badly when I see friends from high school 1 2 3 4 5 who have better cars, clothes, or homes than I do (R) (1, 10)
23. Sometimes when I am good and do my best, I still 1 2 3 4 5 suffer; this is an indication that good does not necessarily triumph over evil (R) (7)
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24. Although I have a favorite kind of music I listen to, 1 2 3 4 5 I can usually get into and enjoy most kinds of music (3, 6)
25. When I am confused or unclear about myself or the 1 2 3 4 5 world about me, I try to push these concerns out of m mind and go on with my life as usual (R) (7)
26. Past philosophers like St. Augustine and Descartes 1 2 3 4 5 are less relevant today than they were 100 years ago before the modern age (R) (6)
27. Despite my religious preferences (e.g. Jewish, 1 2 3 4 5 Muslim, Catholic, etc.), I still believe there are teachings from different religions that are valid (6)
28. I am uneasy and bothered by my responsibilities at 1 2 3 4 5 work and at home (R) (2, 3, 4)
29. I can remain calm and peaceful even when my boss 1 2 3 4 5 blames me for another’s mistakes (1, 3)
30. If I were president, I would invest more money to 1 2 3 4 5 develop social programs and less money in high tech development (4, 8)
31. There are some people in my past who I believe I 1 2 3 4 5 should never forgive (R) (3)
(R) indicates a reverse scored item so that (1=5), (2=4), (3=3), (4=2), (5=1)
Numbers in parentheses reflect the optimal belief dimension the item was designed to assess (1) Spiritual Reality (2) Valuing Interpersonal Relationships (3) Valuing Harmony (4) Valuing Communalism (5) Valuing Experiential Knowledge (6) Holistic Worldview (7) Diunital Logic (8) Extended Self-identity (9) Self-knowledge (10) Intrinsic Self-worth
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APPENDIX L
GIFT CARD E-MAIL TO PARTICIPANTS
Dear Participant, Thank you for participating in the Relationships among Black women’s wellness, gendered-racial identity, and mental health symptoms research study. We appreciate your time and effort in answering the questions. Your eGiftCard is ready to use! Use it online or in store!*
*eGiftCard can only be redeemed in store if converted to a Mobile GiftCard.
Retailer: Target
Amount: $5.00
Card Number: 041-XXX-XXX-XXX-XXX Access Number: 055XXXXX
To redeem your gift card at Target.com: 1. Fill your cart with those items you’ve been eyeing. 2. Enter your Card Number and Access number when checking out, and your gift card will be applied automatically.
*To redeem your gift card at Target Store, visit the app on your iPhone or Android phone, or go to Target.com in your phone’s browser: 1. Tap Account icon. 2. Tap mobile gift cards, Sign into your account (or create one if needed). 3. Select “Add new gift card.” 4. Enter 15-digit Card Number and 8-digit Access number.
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5. Tap Save, balance and barcode will appear.
The Bullseye Design, Target and Target GiftCards are registered trademarks of Target Brands, Inc. Terms and conditions are applied to Gift Cards. Target is not a participating partner in or sponsor of this offer.
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